He stood in the corner of San Francisco’s Department of Motor Vehicles, clutching the handles of his walker and waiting for his turn to apply for an identification card. He’d lost it a few years ago, along with his home, his health and his dignity.

“I recognize those two people right there,” he whispered to me, anxiously, nodding at a man with a long braid and a young woman in a blue dress just feet away.

Ben Campofreda, 41, had smoked fentanyl many times with the pair on the sidewalks of the Tenderloin. He hoped they wouldn’t spot him.

After lifesaving surgeries and a hospital detox, he could stand instead of slumping in his old wheelchair. His long hair, once grimy, was cut short. He wore clean clothes.

Ben had been sober for four months by that September afternoon and aimed to keep it that way. Reconnecting with anyone from his old life, he figured, could jeopardize that. Fortunately, his former friends took no notice of him.

“I love that nobody recognizes me,” he said. “There’s a rumor on the streets that I died on the operating table. I told my dad about that, and he said, ‘Good. Let everybody think that you’re dead.’”

The rumor may be more believable than the truth — Ben had managed to kick fentanyl, the terribly powerful and addictive opioid that has radically changed San Francisco. He told me that of all the friends he made smoking “fetty” on city streets, 40 had overdosed and died. Just one, he said, is in recovery.

I’ve been following Ben since late August because his story exemplifies so much about the cruelty of a city that makes it far easier to buy deadly drugs than to access treatment to leave them behind. But his journey shows there’s hope for the legions of people like him dotting the Tenderloin and South of Market districts in a fentanyl-fueled fugue, often sprawled on the sidewalks or folded over where they stand.

With the help of family and friends, talented health care workers and the resolute determination to be free of addiction, a better life is possible. But the obstacles are significant. The question as I kept in touch with Ben was whether he could hold on to his new sobriety and avoid falling back into the chaos of life on the drug.

In the DMV, the numbers ticked.

“Lucky 13!” Ben said. “I’m next! All right, I’m ready.”

Ben Campofreda, about age 7, at his grandparents’ house in Virginia

Courtesy Judi Johnson

Ben Campofreda, in his early 20s, at a restaurant celebrating his great-grandmother Mary’s birthday.

Courtesy Judi Johnson

Left: Ben Campofreda, about age 7, at his grandparents’ house in Virginia. Right: Campofreda, in his early 20s, at a restaurant celebrating his great-grandmother Mary’s birthday. Photos provided by Judi Johnson. At top of story: Campofreda walks through San Francisco’s South of Market neighborhood to catch a bus to his drug treatment program.
Top: Ben Campofreda, about age 7, at his grandparents’ house in Virginia. Above: Campofreda, in his early 20s, at a restaurant celebrating his great-grandmother Mary’s birthday. Photos provided by Judi Johnson. At top of story: Campofreda walks through San Francisco’s South of Market neighborhood to catch a bus to his drug treatment program.

Ben, who grew up in Virginia, developed spinal stenosis as a teenager; a lack of space in the backbone puts pressure on nerves in his spine. By 20, he had constant, extreme back pain.

A doctor prescribed Oxycodone, and Ben loved both the relief from his pain and the energy the pills gave him. Within a couple years, he’d developed a serious addiction, consuming an entire month’s supply of 120 pills in a day by crushing and snorting them. He found an M.D. who would write prescriptions for more for $100 a pop and supplemented all that by buying pills on the street.

This allowed him to live a successful life as a snowboarding instructor in Colorado, then as a sound engineer and production manager who toured with musicians including the rapper Macklemore.

But the addiction grew stronger, and buying all those pills was expensive. In his early thirties, Ben switched to heroin, which was cheaper.

He moved to Santa Clara with a girlfriend six years ago to be near her family, working remotely for a Colorado company that provides online courses to educate people about cannabis, including how to run successful dispensaries and how to cook with it. He tried to hide his worsening dependence on opioids from his girlfriend, but she was suspicious of his increasingly strange behavior and dumped him after catching him smoking heroin on a camping trip.

His boss fired him too after Ben was high and incoherent during a weed conference in Seattle.

Next came a stint in an RV that he parked in Millbrae, providing an easy starting point for Uber rides into the city to buy heroin. When his RV broke down and was impounded, he couldn’t afford to get it out. So he settled into life on the streets of the Tenderloin, never calling one corner home, but just wandering.

Almost immediately, someone stole his backpack with his wallet and phone. And finally he did what so many have done: He switched to fentanyl, which was cheaper than heroin and far stronger.

He funded his addiction by dumpster-diving, explaining to me that many San Franciscans are so rich that they throw away clothes with tags on them, sunglasses, electronics and toys. He sold whatever items he could salvage by spreading them on a tarp or a blanket at Sixth and Market streets at night.

He often ate breakfast, used the bathroom and got toiletries at Glide Memorial Church or St. Anthony’s and got more goods from outreach workers.

“There was a lot of food offered,” he said. “People would hand out tents and sleeping bags, toothbrushes, deodorant, harm-reduction supplies. They would give out meth pipes, crack pipes, aluminum foil.”

The drugs were the easiest to score of all — dealers were everywhere, and fentanyl was dirt-cheap — and soon his life was entirely centered around scoring his next hit.

“The dealers figured out the science of that one real good,” he said of fentanyl. “It’s a jackpot for them. You constantly need it, you constantly want it and you’ll do anything you can to get it.”

A cop, every so often, would approach him in the Tenderloin and tell him to put his drugs away. He doesn’t recall a single outreach worker offering him treatment on the street, even as the city’s drug crisis grew so severe that one or two people, on average, died of overdoses every day.

He rarely slept at night, using methamphetamines to stay awake, and sometimes stretched out on a pew at St. Boniface Church to doze during the day.

“Everywhere else,” he said, “you’ll just get robbed.”

He managed to get by OK for a while, but then an infection in his legs made its way into his spine, and he couldn’t walk. He became confined to a wheelchair, unable to use the bathroom or get food without help. He normally weighed 170 pounds, but as his health grew worse, he shrunk to a startling 100 pounds. His hands grew red and puffy, a common symptom of opioid use.

“I wasn’t taking care of myself at all,” Ben said. “I didn’t know what was wrong with me.”

Campofreda on the streets of San Francisco shortly before his friend took him to UCSF in the spring for medical help and to beat his addiction.

Courtesy James Nugent

One thousand two hundred and seventy four. By the count of Judi Johnson, that’s the number of days her son was homeless.

“San Francisco reminds me of a Mad Max movie,” she said. “It’s beautiful and the weather’s nice, but I don’t understand how you can let people do drugs on the street like that. It’s not compassion. It didn’t seem like there was any help.”

She flew to the city from Virginia four times to visit Ben and was shocked by his worsening health. The skinny, filthy man in the wheelchair looked nothing like her little boy.

“He was gaunt. He was sick. He was off-color. He had sores,” she said, crying at the memory. “It just broke me. It still hurts to think about it.”

She found him easily each time just by walking around, then offered him help like food, hotel stays and phones he kept losing.

“I never went there thinking I could change him,” she said. “I just hoped Ben would see how much I loved him and come back.”

He didn’t, and when the pandemic struck, she stopped flying out west. She worried about her son during the day and dreamed of him at night, joining a growing number of parents whose children are addicted, homeless and lost here.

“San Francisco reminds me of a Mad Max movie.”

— Judi Johnson

Allison Lawler, 33, Googled her old college boyfriend on Valentine’s Day of this year on a whim. She found Ben’s name and photo in an online essay about San Francisco’s homeless people and their pets. Shocked, she flew south from Oregon.

Arriving one weekend in March, she found her once-vibrant and athletic companion sitting in his own waste in a wheelchair in United Nations Plaza, his back wrecked, his skeletal body nearly folded in half. He was, she recalled, “continuously smoking drugs and having uncontrollable twitches.”

Mayor London Breed had by then opened the Tenderloin Center in the plaza, with a goal of linking the city’s most vulnerable people to housing and treatment, but Lawler learned that it offered no assistance on weekends.

She initially booked a room at the Phoenix Hotel in the Tenderloin, planning to clean Ben up and accompany him to the center that Monday. But after she realized her friend had open, feces-infected sores on his legs, she called 911 against his wishes.

She urged the paramedics who arrived to place him under an involuntary psychiatric hold. They said they couldn’t. One, Lawler said, suggested she wait until Ben fell unconscious from the infection in his legs, then call 911 again. That made no sense to her.

“It’s a slow suicide, right?” she said. “Who are we protecting by letting someone die on the streets?”

Lawler returned in April on a weekday to visit the Tenderloin Center. She said she spent a frustrating day there with Ben, who smoked fentanyl in an outdoor area. (The practice was allowed and may have saved lives, with workers able to administer the antidote Narcan to those who overdosed.)

While the staff was kind, she said, the programs didn’t seem coordinated, and finding housing for someone in a wheelchair seemed particularly difficult. After many hours, staff members gave Campofreda a spot at the Cova Hotel on Ellis Street. But the bathroom wasn’t big enough for his wheelchair and he didn’t stay. Lawler went home again, defeated.

In the nearly 11 months it was open, people made about 123,000 visits to the Tenderloin Center, where basics like food and laundry were plentiful. Center staff members reported making 1,500 connections to housing or shelter, but there were only 397 “linkages” to mental health or substance abuse services.

Whether those referrals were successful is unclear. The city didn’t measure outcomes, a lost opportunity to help more people like Ben recover.

Breed had pitched the center as a conduit to longer-term care. By that measure, it failed. And rather than work to improve it, Breed this month shuttered it with nothing new to take its place for the more than 7,700 people in the city who are homeless and the untold number who are struggling with addiction.

I wanted to ask the mayor about the closure of the Tenderloin Center and whether she considers the city’s treatment system effective, but multiple requests for interviews with her over three weeks were not granted.

James Nugent, one of Ben’s best friends, was trying to find him, too, calling police, homeless aid groups and even the city morgue.

His breakthrough came after contacting Miracle Messages, a nonprofit that aims to reconnect unhoused people with their families. Soon after Nugent called, one of the group’s volunteer detectives, Liz Breuilly, called him back and agreed to search for Ben, finding him quickly.

Nugent flew in from Washington, D.C., in May, met Breuilly and then found his friend smoking fentanyl in United Nations Plaza, his head covered by a dirty jacket.

“He’d hit his drugs and then all of a sudden would be in la-la land for 45 minutes to an hour and then do it again,” Nugent said.

When some addicts fell unconscious, he noticed, dealers stole their belongings. Police officers were scarce. Meanwhile, office workers strolled through the plaza carrying bags of Whole Foods groceries, ignoring the scene around them.

“It looked like a war zone,” Nugent said. “And no one was doing anything about it.”

At one point, Ben asked Nugent to lift one of his legs onto the footrest of the wheelchair because it was dragging on the ground, and he couldn’t raise it. Nugent felt warm liquid. “He was actually peeing on me,” he said.

That was it. He told his friend he was going home and wouldn’t visit again. “I said, ‘I don’t want to remember you like this. I want to remember the good times.’ I think that hit him hard.”

Nugent left for his hotel, but soon received a call from Breuilly. Ben had called her to say he was finally ready to get help.

When they met at 9 the next morning, Breuilly told Nugent to take Ben to UCSF Medical Center, where he would have a better chance at obtaining long-term, intense help than at the smaller hospitals nearer the Tenderloin.

After arriving at UCSF, Nugent and Ben said, medical staff removed Ben’s soiled pants. Maggots fell out of the sores on his legs. Doctors later told Nugent that Ben, if he remained outside the hospital, would have died within a week.

That was May 15. It was the last day Ben used fentanyl or any other illicit drug, he told me. He marks May 16 as his sober date — the day he began to come back to life.

Ben arrived at UCSF Medical Center with osteomyelitis and discitis, severe bacterial infections in his lower back. The infections had eroded his two lowest vertebrae and spread to his tailbone. He was extremely skinny and, in the words of Dr. Alekos Theologis, a UCSF orthopedic surgeon, “depleted of all nutrition.”

“People who are addicted to drugs and who are malnourished and who have a compromised immune system are prone to these infections,” he told me.

What came next, Theologis said, was “miraculous.”

The treatment by a team of surgeons, doctors, nurses, nutritionists, social workers and others began with a complicated surgery to remove bone that was pressing on the nerves in Ben’s back. A second surgery included cutting out the infection and using a metal cage to reconstruct his spine.

Over the summer in the hospital, Ben began to recover the use of his legs. He gained more than 50 pounds. “Even though his recovery was slow, I must say that it was dramatic,” Theologis said.

The team gave him the anesthetic drug ketamine to ease his withdrawal and later prescribed him methadone for the same purpose upon discharge.

Ben, who is on Medi-Cal and paid nothing for his stay, said someone in the hospital told him his care cost more than $1 million. Theologis said he didn’t know the exact figure, but that the estimate “was very possible.”

Dr. Daniel Ciccarone, a UCSF professor of addiction medicine who didn’t work on Ben’s case, called Ben’s transformation “a welcome miracle.” He said he doesn’t know how many people like Ben recover from fentanyl addiction, but called it “unfortunately low.”

“Even though his recovery was slow, I must say that it was dramatic.”

— Dr. Alekos Theologis

Fentanyl is highly potent and addictive. Treatment slots are too few. The federal government heavily regulates methadone to treat it, limiting its availability and requiring frequent trips to licensed opioid treatment facilities to access small quantities. Another drug, buprenorphine, isn’t effective until after a few days of painful withdrawal, Ciccarone said, noting that many patients give up in the meantime.

“You have to be lucky and persistent and know people and be motivated and be ready to go through all the hard work that it means to go through recovery all at the same time,” he said. “People do it, and I find it utterly remarkable and extraordinary.”

Ben, his family and his friends praised the hospital for devoting so much time and effort to him. But at his discharge in August, the city’s lack of a coherent treatment system became clear.

Ben needed to stay nearby for follow-up appointments, but UCSF social workers could not find a good place for him to go.

They recommended a medical respite facility at Eighth and Mission streets. But the corner teemed with drug dealers, and Ben said he had a panic attack when told that was his best option. The only other place the social worker could find, he said, was a medical respite facility in Oakland.

Ben went there with a prescribed stash of painkillers for his back and methadone to curb his cravings, expecting someone would keep it for him and dole it out in small quantities. Nobody did. He stayed alone in a room with piles of drugs, frantically trying to find a program that fit his needs.

In late August, Breuilly, the Miracle Messages detective, reached out to me. She’d been phoning her contacts, asking where someone who had three months of sobriety and no home could go. She couldn’t find anything.

Ben Campofreda, a recovering fentanyl addict, walks back from the pharmacy in Oakland, Calif., on Friday, Sept. 2, 2022. He is recovering from multiple surgeries in a respite in Oakland before seeking drug treatment.

Gabrielle Lurie / The Chronicle

“I’m so desperate to help him, I could just scream,” she told me in one of our conversations. “He is scared to death. He doesn’t leave his room.”

Ben and I started chatting, and he provided regular updates. He said he left “dozens” of messages at city agencies and treatment centers, but either didn’t get calls back or received contradictory information.

“It’s been a lot harder than I planned,” he said. “They keep asking me if I have a case worker, but they can’t tell me how to find one.”

A UCSF social worker suggested he visit the Tenderloin Center — and he did, wearing a ball cap, sunglasses and COVID face mask as a disguise in hopes of avoiding his old friends.

He’d visited the center about a dozen times before, but only to smoke fentanyl and meth in the back, lured by free meth pipes and the ease of bumming drugs off fellow users. He said San Francisco should create overdose-prevention sites, but also drug-free places to seek treatment.

“I was literally looking out a window watching someone use while I’m trying to find rehab and trying to stay sober,” he said.

“I’m so desperate to help him, I could just scream.”

— Liz Breuilly, Miracle Messages volunteer

Ben said he visited the center five times in the fall, but it never led to much help. Once, after being assessed for housing, he said he was told he didn’t qualify. Another time, he said a staffer recommended visiting the office of HealthRight360, a treatment program, “to introduce himself.”

He said a staffer at HealthRight360 asked why he was there since he was already sober. “I’d like to stay that way,” he responded. He said he was told it was too late in the day to enter the nonprofit group’s detox program, but that he could come back the next day and try again.

UCSF provided car rides from Oakland, but needed several days of advance notice. Ben said he wanted to make sure HealthRight360 could place him immediately if he went back. He said he called the nonprofit and left messages that weren’t returned.

He grew increasingly frantic. He knew his recovery was fragile.

Ben should have been able to get treatment at any hour of any day. San Francisco voters in 2008 passed a measure mandating it. But 14 years later, the city is far from reaching it.

At a recent Board of Supervisors hearing, officials with the Department of Public Health were adamant that San Francisco offers treatment on demand, but advocates say that’s not true.

San Francisco has no nighttime or weekend options for seeking treatment, makes little effort to proactively educate people addicted to drugs about treatment options, and offers no navigators to help people figure out the bureaucratic treatment system once they’re ready. For people like Ben, who are already on the edge, the system needs to be a lot more supportive. Any delay or confusion can be devastating.

Department of Public Health officials said in a statement that 4,544 people received drug treatment — including methadone to curb cravings, outpatient treatment and residential treatment — through its programs in 2021. The wait time for methadone programs is less than one day, and the wait time for 90-day residential drug treatment is four days, they said.

The department said people seeking treatment should visit the Behavioral Health Access Center at 1380 Howard St., from 8 a.m. to 7 p.m. on weekdays, or call the center 24 hours a day at 415-255-3737.

I called the number recently and, as a test, asked how someone can get treatment for a fentanyl addiction.

The call-taker said to visit the Howard Street center, but noted it was open for intake only from 9 a.m. to 5 p.m. on weekdays and was closed for two hours Wednesday afternoons. He said detox was usually available quickly, but that securing outpatient or residential treatment could take up to two weeks.

Critics of the city’s system say people addicted to drugs often hit rock bottom at night or on weekends and that if they can’t get immediate help, they may seek fentanyl.

I described Ben’s plight to Dr. Hillary Kunins, the city’s behavioral health director. “It’s important feedback for us to receive, and we want to make sure people know how to get help,” she said, noting she intends to expand the hours for the Howard Street facility.

She said outreach teams do “motivational interviewing” in which they ask addicts what they need but also urge them to change their behavior.

But Sara Shortt, co-chair of the Treatment on Demand Coalition, an advocacy group, said the city needs to improve its treatment services and ensure that people addicted to drugs know about them and can access them.

“Much more public education needs to be put out there, and in some cases, people really need more navigators or case managers or people who are going to hold their hand through the process,” she said. “All of that is nonexistent for the most part.”

San Francisco has a new advocate for people like Ben in Supervisor Matt Dorsey, who’s in recovery himself after years of alcohol and crystal meth addiction. He smartly wants to task police with keeping dealers away from blocks with treatment facilities. He wants treatment intake available 24/7, a 311-like call center for people seeking help and a response team available to pick them up within an hour and help them navigate the process.

He said he recently helped a friend addicted to crystal meth access treatment, a process he found frustrating and confusing.

“This is never going to be the issue of the month for me,” he said. “I consider it the obligation of my survival.”

Ben made a Sept. 22 morning appointment at HealthRight360, and I asked permission to attend. That’s when things finally clicked. They told him he could move into a treatment facility on the edge of Buena Vista Park that day.

“That’s awesome!” Ben said. “I’m stoked.”

Getting into detox can happen quickly if someone shows up by 3 p.m., said Vitka Eisen, executive director of the nonprofit. But she acknowledged that a city that truly offered treatment on demand would have it available all day, every day and would be more explicit about how to get the help. She said a staffing shortage has made offering immediate treatment even more challenging.

I visited Ben at the Buena Vista Park facility the following week, and he seemed calm and happy. He described attending morning meetings in the chapel and walking in circles around the large room in the afternoon for exercise. He attended online Narcotics Anonymous meetings and had been connected to a doctor, a psychiatrist and a dentist to pull meth-rotted teeth.

“It’s been really great here,” he said. “The program is awesome now that I’m in it.”

After a couple of weeks, he moved to a longer-term treatment facility on Hayes Street. Now, he can go for walks outside. All participants must perform jobs; he folds laundry.

He talks to his parents every day, and numerous friends have visited. He voted on Election Day and celebrated Thanksgiving at the facility with turkey and stuffing. He’s recording a podcast called “Rehab Undercover.” Perhaps most stunningly, he no longer needs his walker and can walk and climb stairs with ease.

Ben Campofreda is dropped off at HealthRIGHT 360 in San Francisco, Calif., Thursday, Sept. 22, 2022. Campofreda began his 90 day-residential treatment in his attempt to stop his fentanyl addiction.

Santiago Mejia/The Chronicle

Ben Campofreda arrives at HealthRIGHT 360 in San Francisco, Calif., Thursday, Sept. 22, 2022. Campofreda began his 90 day-residential treatment in his attempt to stop his fentanyl addiction. He sits in an office to process his paperwork before going to the treatment center.

Santiago Mejia / The Chronicle

Left: Ben Campofreda is dropped off at HealthRIGHT 360 in San Francisco on Sept.Santiago Mejia 22. Right: He sits in an office to process his paperwork before being admitted to the treatment center. Photos by Santiago Mejia/The Chronicle
Top: Ben Campofreda is dropped off at HealthRIGHT 360 in San Francisco on Sept.Santiago Mejia 22. Above: He sits in an office to process his paperwork before being admitted to the treatment center. Photos by Santiago Mejia/The Chronicle

Campofreda walks through HealthRight360’s Walden House in San Francisco, where he was undergoing his drug rehabilitation.

Gabrielle Lurie / The Chronicle

Ben Campofreda, a recovering fentanyl addict, shows off his bracelet reading “ Every Day Counts” while in his room in rehab at Walden House in San Francisco, Calif., on Saturday, Nov. 6, 2022. He is recovering from multiple surgeries while getting drug treatment.

Gabrielle Lurie/The Chronicle

Ben Campofreda, a recovering fentanyl addict, (right) meets with his therapist to discuss his progress in San Francisco, Calif., on Friday, Oct. 7, 2022. He is recovering from multiple surgeries while getting drug treatment.

Gabrielle Lurie / The Chronicle

Ben Campofreda, a recovering fentanyl addict, organizes a piece of laundry at his drug rehabilitation program at Walden House where hopeful messages are on the walls in San Francisco, Calif., on Saturday, Nov. 6, 2022. He is recovering from multiple surgeries while getting drug treatment.

Gabrielle Lurie / The Chronicle

Left: Ben Campofreda shows off his bracelet reading “ Every Day Counts.” Top right: He meets with his therapist to discuss his progress. Bottom right: Campofreda does laundry at his drug rehabilitation program at Walden House in San Francisco. Photos by Gabrielle Lurie/The Chronicle
Top: Ben Campofreda shows off his bracelet reading “ Every Day Counts.” Middle: He meets with his therapist to discuss his progress. Above: Campofreda does laundry at his drug rehabilitation program at Walden House in San Francisco. Photos by Gabrielle Lurie/The Chronicle

Ben Campofreda organizes chairs in a meeting room at Walden House’s 30-day detox center in San Francisco.

Gabrielle Lurie / The Chronicle

He plans to enter a HealthRight360 step-down facility where he’ll be able to live for a year or two while getting help seeking a job. He hopes to become a drug counselor.

Dec. 16 marks his seven-month-sober date. His mom and friends still can’t believe their happy, healthy guy is back. A miracle, his mom calls it. Like winning the lottery, his ex-girlfriend said. As good an outcome as one could have possibly hoped, his surgeon told me.

He goes back to his old stomping grounds for methadone appointments and no longer worries about getting recognized by his old friends.

“I hope that when people see me out there and see what I’m doing, it can maybe be a glimmer of hope for them,” he said.

And he no longer worries much about succumbing to the lure of fentanyl.

“Actually, it’s the complete opposite,” he said. “I can’t believe that s— had such a crazy hold on me. It’s like being held hostage.”

But now, at last, he’s free.

Heather Knight is a San Francisco Chronicle columnist. Email: hknight@sfchronicle.com Twitter: @hknightsf

Campofreda greets a friend he had used drugs with on the streets after a therapy session in San Francisco.

Gabrielle Lurie / The Chronicle

The post He was days from demise. Right here’s how he kicked fentanyl and bought off San Francisco’s streets appeared first on Los Gatos News And Events.

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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It’s 9am in San Francisco’s Tenderloin district and sleeping bodies line the sidewalks as Felanie Castro sets out on her route in Glide Memorial church’s harm reduction van.

Along Ellis Street, hungry people queue up for the church’s daily breakfast of buns, hard-boiled eggs and plastic-wrapped muffins. Down the block, a fire department truck, part of a city response team, awaits the day’s first drug overdose call.

This neighborhood and the adjoining South of Market (SoMa) district have become ground zero in an opioid overdose crisis that is killing thousands of California residents, including many experiencing homelessness. In the past two years, more than 1,300 people have died of overdoses in San Francisco, a rise driven by the emergence of fentanyl, a super-potent synthetic opioid that’s 50 times stronger than heroin. Nearly half of those deaths have occurred in these two hard-hit neighborhoods alone.

Castro and Glide’s harm reduction team are fighting one front in the battle to keep people alive.

Glide, a nearly century-old church, has been advocating for the rights of the poor and disenfranchised communities since the 1960s. Today the church runs dozens of programs, including support for those struggling with homelessness and addiction. Armed with supplies such as clean syringes, glass pipes, alcohol wipes and bottles of water, their team aims to give people the health tools to make drug use as safe as possible, while working to build the trust that drug users may need to eventually seek help.

Among the most powerful tools in their arsenal are nasal spray bottles of Narcan, each containing 4mg of the life-saving opioid-reversal drug naloxone. Castro says she has already reversed 50 overdoses using Narcan, in the Tenderloin and around the city.

But she can’t save everyone alone. As part of a broader harm reduction strategy, providers are offering Narcan at clinics, meal programs and homeless drop-in centers and distributing it directly into the hands of drug users and anyone living around them, increasing the chances someone can act.

“The idea is to have Narcan available everywhere,” said Laura Guzman, a senior director at the National Harm Reduction Coalition. .

Left: The Tenderloin neighborhood. Right: Felanie Castro in front of Glide Memorial church. Photograph: Balazs Gardi/The Guardian

As the Glide outreach van pulls up to a collection of tarps and tents under the shadows of a freeway overpass that morning, Castro and her partner, Rizzy Spoer, call out to the occupants, who appear to be sleeping inside.

“Hi, sorry to bother you. We’re from Glide. We have harm reduction supplies and basic needs stuff. Do you need anything?”

A bearded young man in a baseball cap comes out and asks if he can have some “longs” and some “shorts”, referring to two different sizes of syringes.

Castro loads a paper bag with the supplies and offers some water. Then she calls to the soft-spoken young man as he turns to go back to the tent: “And also, do you have any Narcan in there?” The man gratefully takes a single-dose Narcan dispenser wrapped in foil packaging.

A historic neighborhood faces new crises

The Tenderloin, a historic neighborhood in the heart of San Francisco’s downtown, comprises roughly 50 square blocks, most built just after the 1906 earthquake. During the 20th century its gently sloping streets and residential hotels developed a reputation as the city’s seedy underbelly, known for drug dealing, sex work and vice.

Today the Tenderloin is grappling with the interlocking crises of homelessness, poverty and addiction. It’s home to hundreds of people trying to survive without housing, many living just steps from glitzy high-rise apartments, luxury brand shops, and the headquarters of tech companies such as Twitter and Uber.

The city supervisor Matt Haney, who represents and lives in the district, describes it as a place of last resort for people who have fallen through the social safety net.

“The Tenderloin is a place where people who have been pushed out, stepped on and who are struggling can find a home and refuge,” he said. “That’s a powerful and beautiful thing. It also brings with it a lot of need.”

Bar chart of opioid overdoses reversed trending up, overdose deaths climbing and then falling in San Francisco

In recent years, new forces have intensified those challenges. One is the rise of fentanyl, now the substance of choice for many illicit drug users in San Francisco. Another is soaring rents and a statewide housing crisis that experts say has pushed even more people on to the streets.

Resolving the situation has become one of the city’s most divisive issues. Facing mounting pressure to act, San Francisco’s mayor, London Breed, declared a “state of emergency” in the Tenderloin in December 2021 – promising a crackdown on drug dealers, more interventions for users and cleaner streets.

The declaration reignited a debate at the heart of drug addiction treatment: should users be given “tough love” and urged to abstain from drug use? Or should the city make drug use safer and help people rebuild their lives at their own pace?

Opinions range, with some in favor of the abstinence-based approach, a philosophy often associated with America’s “war on drugs” era, and some who want the city to use a firmer hand to clear the Tenderloin of visible drug use and encampments.

People in the Downtown Streets program, which assists people who have experienced homelessness, clean the Tenderloin in March.Ramona De La Torres, a worker with the San Francisco Drug Users Union, a harm reduction organization that distributes syringes and other supplies to make drug use safer.

In contrast, harm reduction advocates say widely accepted scientific evidence shows this strategy is ineffective at reducing addiction in the long term. In addition to placing people in supportive housing, they believe the city should open supervised spaces for people to use drugs, so they can receive prompt medical attention in the case of an overdose. Slowly building relationships, they say, helps people get into treatment and ultimately heal.

“Harm reduction is sort of the flip side of criminalizing drug use,” said Glide Memorial church’s CEO, Karen Hanrahan. “We practice harm reduction to save lives and to reduce disease, but also because it builds relationships with people who we can then wrap our arms around and help them through a continuum of other services that they need.”

Harm reduction started as an underground movement distributing clean needles to drug users during the Aids epidemic of the 1980s, said Dr Daniel Ciccarone, a professor specializing in addiction medicine at the University of California, San Francisco. The mantra, at a time “when injection drug users and men who had sex with men were not only ignored, but were vilified”, says Ciccarone, “was meeting people where they’re at – not judging them, not disciplining them, not telling them what they needed to do.”

Those principles now form much of what we think of as drug treatment, he said, from the use of medicines like methadone and buprenorphine to help wean people from opioids, to the counseling that helps people rebuild their sense of dignity. And for the first time, harm reduction became part of federal policy when the Biden administration included it as a pillar of its plan to stem national overdose deaths.

“It started scrappy; it started low-budget and it started underground,” said Ciccarone, who worked with street activists in the 1980s trying to stop the spread of Aids. “It has grown to become legitimate, accepted, funded and politically approved.”

‘I’m scared to death of fentanyl’

Proponents of harm reduction are putting their methods up against one of the greatest tests yet as fentanyl floods the US drug market.

In California, the number of fatalities attributed to fentanyl jumped by more than 2,100% in five years. In San Francisco, overdose deaths hit a new high of 711 during the first year of the pandemic, with those experiencing homelessness facing some of the highest mortality rates.

A man smokes fentanyl in the Tenderloin.

According to Alex Kral, who has been interviewing opioid users for decades as part of his work with the non-profit research institute RTI International, many heroin users have switched over to fentanyl – which is being both injected and smoked – because it’s a cheaper and quicker high. But the drug’s extreme potency means that even longtime opioid users can quickly go into a breath-stopping overdose.

That’s made distributing Narcan even more urgent. While there’s no silver bullet for the crisis, experts say many more would be dying without it.

For example, in 2021, after climbing precipitously for three years, the number of overdose deaths in the city decreased slightly to 650, a period that coincided with Narcan resuscitations ramping up significantly – from 4,300 in 2020 to 8,200 in 2021.

.

Several months ago, Laurie Rudner, a former Tenderloin resident, saw for herself just how fast fentanyl can take someone out.

A friend was sitting in front of her in a wheelchair when he took a hit of the drug. Almost instantly, she saw the drink he was holding drop out of his hand. Fortunately, Rudner had been given some Narcan. She pulled it out of her bag, and she and another friend rushed to their fallen companion and squirted the Narcan up his nose.

Arlen Fernandez, a Gulf war veteran, in the Tenderloin. Fernandez recently got housing with help from the city. Photograph: Balazs Gardi/The GuardianMike Brodeur has been struggling with opioid addiction since his teens. He worked in a demanding position as a towing company manager for many years but is now unhoused and feels like there’s no help available for him. Photograph: Balazs Gardi/The Guardian

An ambulance arrived quickly and administered several more doses of the antidote and, pretty soon, Rudner’s friend was breathing again and on his way to the hospital.

“The main problem right now is fentanyl,” said Rudner. “There have been like two deaths a day.”

While the drug is killing everyone from Hollywood celebrities to high school teenagers, it has posed a particular threat to people experiencing homelessness, driving a doubling of deaths among this group during the first year of the Covid-19 pandemic, according to a UCSF study.

One big difference between the late 1990s and now, said Kral, is that back then only about 30% of all injection drug users surveyed considered themselves homeless. Today, the figure is 75% to 80%.

He believes the difference is that much of the cheap, marginal housing – like $20-a-night hotels, warehouse spaces and abandoned buildings – has disappeared and been replaced by high-rise condominium buildings fetching top dollar from tech industry employees.

Laurie Rudner in the Tenderloin. ‘The main problem right now is fentanyl,’ she said. Photograph: Balazs Gardi/The Guardian

“People no longer have places to be,” he said.

Reginald Dillard Sr, 65, says what he sees happening on the streets now terrifies him. Born in San Francisco, he has lived in the Bay Area his whole life. After his family lost their West Oakland home in the 2008 housing crash, Dillard said, “I did a few too many drugs and I ended up on the sidewalk.”

Dillard spent years living on the streets in the Tenderloin before he got help from a city caseworker and, four years ago, moved into a subsidized one-room apartment in an old Tenderloin hotel. Now he surveys the street scene around Glide from a distance, looking sharp in a white and blue windbreaker, jeans and a baseball cap.

“I’m scared to death of fentanyl,” he said. “It don’t take but a match head’s worth of that stuff to put you out for good.”

Twenty-nine-year-old Eletise Niumata has experienced those dangers first hand. Sitting in a wheelchair a few blocks from Glide church, she places pink fentanyl powder on a square of tin foil and holds a lighter underneath, inhaling the rising fumes through a straw-like tube.

Left: Reginald Dillard Sr in the Tenderloin. Right: Luxury housing in high-rises sprouting on the edge of the Tenderloin. Photograph: Balazs Gardi/The Guardian

Between puffs, Niumata explains that her name means “electricity” in her ancestral homeland of Samoa, a place she visited twice while growing up in San Francisco. In recent years, both she and her younger sister have faced homelessness. She’s been trying to get into housing, but hasn’t managed to yet.

Niumata says she’s overdosed and been revived by naloxone two or three times. With Narcan, “everybody can help out. If you need some, probably somebody has it.”

Harm reduction on the frontlines

Recently, the city opened a “linkage center” in the Tenderloin, providing a place for those without housing to get respite and hook up with services such as treatment and housing referrals. The center offers hot meals, restrooms and showers – and people are allowed to use drugs in a fenced outdoor area, a decision that not everyone agrees with.

Since the linkage center opened in January, 35 drug overdoses have been caught and reversed with Narcan, according to a statement from the city’s health department.

Finding housing for people who visit the center has been a much slower process. The city’s website shows that as of 10 April, the linkage center has received 28,984 visits and provided 1,220 referrals to services, yet the city’s housing data for the project show only 99 people have gotten housing, with another 71 placed on a priority list. The linkage center made an additional 366 placements into temporary shelter beds.

In Glide Memorial’s outreach van, Felanie Castro is trying to make a difference one visit a time.

The van comes equipped to provide testing for Covid-19, HIV, hepatitis C and a variety of sexually transmitted diseases. The team also passes out lots of bottled water, feminine supplies, snacks, and self-heating meal kits, in varieties like “rotini and kielbasa sausage in a spicy sauce”.

Naaman Harris, left, and his friend Myrin. Harris moved to the Tenderloin from the east coast recently. He heard it was an easier place to live without housing. Photograph: Balazs Gardi/The Guardian

Smoking supplies, including tin foil, straws and glass pipes, are increasingly in demand. Distributing the materials has raised controversy at the federal level – after conservatives erroneously charged that federal money was going to be used to pass out “crack pipes”.

But no federal funding goes to glass pipes, and Castro dismisses criticism that her work encourages drug use. “We’re not just here to give out stuff,” she said. “Everything we do out here is public health. We want to lower the barriers to getting help. That’s my job: lowering the barriers to physical health or mental health.”

Once a week, a doctor from the city of San Francisco’s street medicine team rides along in the harm reduction van and offers medical services to anyone who wants them. The mobile doctors are even able to start people on drug-assisted treatment, a method favored by harm reduction specialists, that can help them get off opioids without the excruciating withdrawal symptoms.

Frank Vaccari, who now lives in a residence hotel in the Tenderloin, credits the earliest form of medication-assisted treatment available in the United States, methadone, with getting him off heroin and off the streets more than two decades ago.

“I couldn’t get off cold turkey,” he said “When I tried, it was horrible. You couldn’t eat. You couldn’t sleep. You’re throwing up. Your eyes are ready to pop out of your skull. The physical effects go on for weeks. Then there’s the mental effects.”

Frank Vaccari at the lobby of the Alexander Residence, a building that provides affordable housing. Photograph: Balazs Gardi/The Guardian

Vaccari, 63, goes to the methadone clinic three days a week to pick up his treatment, which comes in the form of a pink syrup, which he said “tastes nasty, but works real good” to stave off withdrawals.

Many other people he knows have died of overdoses. In January, Vaccari found his younger brother dead of a fentanyl overdose in his own apartment.

As Vaccari steps out on to the Tenderloin’s Eddy Street in his purple pajama pants to give his chihuahua, Cleo, a quick walk, he credits the harm reduction philosophy for keeping him alive.

“Methadone saved my life,” Vaccari said. “I would have been dead years ago.”

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She quit her job, gave up her apartment and packed her almost entirely purple wardrobe in boxes. To save her daughter’s life, Laurie Steves gave up her own.

She left a suburb of Seattle early on the morning of May 13, heading south in her beat-up red Chevy Impala, its odometer pushing 140,000 miles. She had one aim: reaching San Francisco to save Jessica DiDia, the 34-year-old daughter she hadn’t seen in nine years.

The spunky little girl with the huge smile and love of the limelight was long gone. Laurie didn’t know much about Jessica’s life now, but she knew she was homeless in the Tenderloin and addicted to fentanyl and had escaped death from overdosing many times with a lucky shot of Narcan.

Laurie Steves surveys her room in Port Orchard, Wash., as she packs her belongings before moving to San Francisco to try to help her daughter get sober. She moved to San Francisco with the idea that she would stay there for “as long as it takes” for Jessica to get clean. Gabrielle Lurie / The Chronicle

Laurie, 56, couldn’t lose another child. Jessica’s little brother, Zachary, had died alone in December after overdosing on fentanyl and ketamine. He was just 25. Laurie began her drive with Zachary’s ashes by her side.

“I talk to him sometimes,” she said. “I just tell him how much I miss him and how much I know he wanted me to save Jess. And I’m doing it.”

Laurie dreamed of leaving San Francisco with Jessica in the passenger seat, ready to enter long-term residential drug treatment and start a healthy new life. But she didn’t know what she was up against: the perilous collision of a city wholly unprepared to address its fentanyl crisis and the heartbreaking pull of addiction.

Laurie Steves gets a glimpse of Mount Shasta as she makes the two-day road trip from Port Orchard, Wash., to San Francisco in an attempt to help her daughter, who is addicted to fentanyl and homeless. Gabrielle Lurie / The Chronicle

Laurie had emailed me two weeks before her move.

“My name,” she wrote, “is Laurie Steves and I am trying to get my addict daughter off the streets of the Tenderloin. … Her younger brother died of a drug overdose four months ago. I cannot lose another child. Is there some way you can help?”

I had one way to help: tell her story.

When Laurie left Washington, she didn’t know how daunting it would be to lure Jessica away, but she understood what was at stake. She knew that 712 people died of drug overdoses in San Francisco in 2020, and that 2021 was racking up similar numbers. That’s nearly two corpses, on average, taken to the medical examiner’s office every day.

“It makes me wonder,” Laurie said as we talked shortly after her arrival, “when is my daughter going to be one of those two?’”

Laurie Steves unloads her car after the two-day road trip from Port Orchard, Wash., to San Francisco. Gabrielle Lurie / The Chronicle

Laurie arrived in San Francisco with only about $1,000, mostly donations from family. She rented a room in a Bayview home for $1,100 a month — exactly double what she paid for rent in Port Orchard, Wash. She had no trouble paying her bills back home on her $17.69 hourly wage as a cook in a nursing home, and she hoped her finances would pencil out here, too.

She decorated her new room in purple. She placed Zachary’s ashes and a large photo of him on her nightstand. She thumbed through photo albums she’d brought with her — of Jessica and Zachary and her middle child, Lauren, 32, now living with her husband and kids in Florida.

Laurie tried to stay positive, but she sometimes lingered on her regrets as a mom and the painful memories of her own childhood.

Laurie Steves puts her hand to her head as she watches an episode of the TV series “Private Practice” in which a character overdoses on drugs. Gabrielle Lurie / The Chronicle

Laurie was one of seven kids born to parents who battled intense alcohol addiction, and she was in and out of foster care starting at just 6 months old. Another couple — already raising four kids of their own — adopted the entire brood when Laurie was 5. Laurie described her adoptive parents as hardworking and loving.

She said she was sexually abused as a child, and by age 15 she was skipping school, drinking, using marijuana and speed, and cutting herself. She showed me scars on her arms. She said she was diagnosed with depression.

Laurie dropped out of high school but got her GED and was managing a convenience store when she met Ray DiDia, a customer, when she was 20. He was 11 years older. They got pregnant with Jessica within months.

“My mother threw a fit. She said, ‘You don’t need a child right now,’ ” Laurie recalled. “I didn’t think twice. I wanted to be a wife and a mother. I wanted two little girls, and I got them.”

The contentious marriage was over within a few years, and decades later, the bitterness between Laurie and Ray, now retired and living in Florida, remains. In an interview, Ray called Laurie self-involved and said she wasn’t a loving, hands-on mother. Laurie said Ray was abusive, which he strongly denies.

Jessica DiDia growing up: At about 13, in her eighth-grade school picture in Brick, N.J., in 2001. At age 2, moments after winning 10th runner-up for the Little Miss Hemisphere pageant in 1989 in Camden, N.J. At 19 months, being held by mom Laurie Steves on a 1988 visit to Disney World. Provided by Laurie Steves

At first, the girls mostly lived with Laurie. Jessica was an attention-seeking spitfire, competing in beauty pageants such as the Little Miss Hemisphere contest and joining a competitive cheerleading squad. But Laurie noticed a change when Jessica was 9. Her daughter grew depressed and defiant. She and Jessica, both headstrong, fought constantly.

When she was nearly 10, Jessica wanted to live with her dad, and Laurie agreed, thinking it would give them a short break. She thought Jessica would realize life wasn’t better at her dad’s, but in some ways, it was. The businessman had more money. He had stepkids for her to play with. They took vacations. Jessica never moved back.

“In hindsight, I never would have done that,” Laurie said.

A few years later, Ray won custody of their second daughter, Lauren, too, and Laurie was heartbroken. She saw them on some weekends and holidays.

Life repeated itself with Zachary, the son Laurie had with her second husband. After divorcing Zachary’s father, Laurie had a brief third marriage and moved to Washington with that husband. She left Zachary at age 16 in Pennsylvania with his dad.

“I was just flat-out absent,” she said. “I regret I didn’t have more of a hand in what was going on in their lives.”

Lauren Slobod, Jessica’s sister and Zachary’s half sister, is still close with both her parents and said she respects her mom for trying to make amends with her children and for upturning her life to try to help Jessica.

“I’m really proud of her,” she said. “My mom had literally nothing and went to San Francisco with zero dollars and just a prayer and a little bit of hope that she could find Jess.”

Jessica DiDia, 34, who is homeless and addicted to fentanyl, sits on her suitcase on San Francisco’s Turk Street after smoking crack. Gabrielle Lurie / The Chronicle

Laurie and Ray don’t agree on much, but they both said Jessica started using drugs in her teens. Jessica, who Laurie said was diagnosed with depression and bipolar disorder, eventually left home at age 17 for Las Vegas and then Southern California. She visited San Francisco in 2012 at 25 for a Phish concert and has remained here since.

Shortly after moving to San Francisco, Jessica appeared in a 2013 episode — titled “San Francisco Meth Zombies” — of the National Geographic show “Drugs Inc.”

Wearing her red hair in a poofy ponytail, she told the camera, “Somebody told me when I first moved here a couple months ago, ‘People don’t come here to live. They come here to die.’ I’m hoping I don’t make that statistic true.”

Jessica tried drug treatment, but it never stuck. She landed in jail — in 2019, news reports show, police arrested her on suspicion of receiving stolen property and violating her probation after she was found sitting with bags of items taken from the car of students on a field trip to the Hall of Justice.

She was repeatedly hospitalized, including about four years ago for surgery after a staph infection from a dirty needle reached her brain. She has suffered seizures ever since. Ray visited her in the hospital, the last time he saw his daughter. She would connect with her family every now and then — usually when she was temporarily clean. But when she was using, she disappeared for long stretches. Laurie had heard from her on the phone only once in four or five years.

Those years of silence and longing are common, said Liz Breuilly, who helps play detective for Miracle Messages, a nonprofit that aims to connect homeless people and the relatives who miss them. More than 700 families from around the country have requested her services so far, and many of their lost children were last spotted in San Francisco.

Is there a common thread among those kids, missing somewhere on the city’s streets?

“Yeah,” she responded immediately. “Fentanyl.”

Jessica DiDia, 34, Laurie Steves’ daughter, looks through a hole in the window of the American Conservatory Theater on Market Street in San Francisco after buying crack at Seventh and Market streets.  A poster reading “Missing Jessica” hangs in a corner store window on Turk Street. Jessica’s mom, Laurie Steves, posted flyers all over the Tenderloin to try to track down her daughter. Laurie Steves cries out of frustration after several unsuccessful attempts to find Jessica in the Tenderloin. Gabrielle Lurie / The Chronicle

Before moving to San Francisco, Laurie had flown to the city for a couple of days in April, posting “missing” signs with her daughter’s face all over the Tenderloin. She searched and searched, but no Jessica.

A paramedic skirted privacy laws and looked up Jessica’s name in his computer. She’s a “frequent flier” at local hospitals, he told Laurie. Between her daughter’s seizure disorder and repeated overdoses, Laurie wasn’t surprised. But she was disturbed at what she saw in the Tenderloin.

“I’m stepping over people on the sidewalk who have needles in their legs, and people are puking on the street,” she said. “It was a horrible experience, and to know my daughter is living that life, and all they’re doing is handing out tents for them to get high in instead of getting the dealers off the streets — I was shocked.”

After striking out in San Francisco, Laurie returned to Washington and soon got a critical call. Adam Mesnick, the owner of the Deli Board in the South of Market district, saw one of the flyers she had left behind and called Laurie. He knew Jessica from the neighborhood and worried that the posters meant she was dead.

He and Laurie continued to exchange calls and messages, bonding over their shared assessment of San Francisco’s failed response to its drug crisis — that its live-and-let-live attitude amounts to negligence and makes life far harder for people like Jessica.

Adam runs a controversial, in-your-face Twitter account called @bettersoma that shows the city’s drug crisis close up, angering some advocates who say he is insensitive and exploits homeless people. He argues that the tweets depict a reality that City Hall politicians and homeless advocates are unwilling to face. A recovering alcoholic himself, he said he wants more police presence, incarceration for dealers and far more treatment for people addicted to drugs. He doesn’t think the city’s focus on harm reduction is working.

Adam Mesnick, owner of the Deli Board sandwich shop, searches the Tenderloin for his friend Jessica DiDia, who is homeless and using fentanyl. Adam saw “Missing Jessica” posters around the Tenderloin and called the number on the sign, which eventually led him to Jessica’s mother, Laurie Steves. Gabrielle Lurie / The Chronicle

“I try to depict the truth of what’s really happening,” he said.

One of those truths? That the city’s homeless and drug crises are deeply intertwined. The city’s last homeless count found 8,011 homeless people in San Francisco — 42% of them, like Jessica, struggling with an alcohol or drug addiction.

While his online persona can be edgy, Adam is engaged in the lives of homeless individuals and posts videos of them sharing their stories. He gives them free sandwiches, money, odd jobs and a listening ear.

Adam told Laurie he would try to help, but he wasn’t optimistic. He didn’t think Jessica was ready to change her life. He didn’t even think she was ready to see her mom.

Laurie tried for a couple of weeks after her move to find her daughter by working the phones and following up on tips from her still-posted “missing” flyers. Meanwhile, Adam kept an eye out for Jessica. But Laurie’s bank account was draining, with no money coming in. Increasingly desperate, she decided to search the Tenderloin herself.

She didn’t know the neighborhood and walked in circles with dealers calling out to her, offering drugs. She looked at everyone hunched over or passed out, trying to identify her daughter. She wondered: Where were the family members of those lost souls?

“But then I would stop and think to myself, ‘Well, where the hell have you been the last nine years?’ ” she said.

Two days later, Laurie headed back to the Tenderloin for a protest organized by another mother with a homeless child addicted to drugs.

She had exchanged Twitter messages with Jacqui Berlinn, who lives in Livermore and is furious that San Francisco mostly looks the other way at dealers selling poison at Turk and Hyde streets to people like her son, Corey.

Jacqui spoke at a protest across the street from the open-air drug market, the dealers scattering when protesters and camera crews showed up.

“He calls this Pleasure Island, like in Pinocchio — you can just enjoy all the candy,” Jacqui said of her son. “People say you have to hit rock bottom. But my son’s rock bottom is death. I know that.”

Laurie said it made her feel less alone to know other parents faced the same struggle. She carried the big poster board with Zachary’s face on it.

After a rally calling for stopping the spread of fentanyl, Laurie Steves gets on her phone in San Francisco’s Tenderloin. Laurie’s son, Zachary, died in December of a drug overdose, and her daughter Jessica has been homeless and addicted to drugs in San Francisco for a decade. The death of her son propelled Laurie to try to save her daughter. Gabrielle Lurie / The Chronicle

Supervisor Matt Haney, who represents the Tenderloin and lives a block from the open-air drug market, gave an emotional speech and said all the things Jacqui and Laurie wanted to hear. That the neighborhood hates the drug trade. That it’s destroying families. That there must be intervention for people addicted to drugs. That there must be “effective, meaningful prosecution” for dealers from the district attorney.

“This is killing more people in our city than anything else by far,” he said.

He was right. In 2020, 712 people died of drug overdoses, compared with 257 who lost their lives to COVID-19, 48 who were victims of homicide and 30 who lost their lives in traffic collisions. When the pandemic struck, just about the entire city government flew into action, but the drug crisis had seen comparatively little response. An outreach team here, some more treatment beds there. But no all-hands-on-deck wartime effort.

“Every single elected official should be here,” the supervisor continued, his voice rising in anger and his face turning red. “Push us to do more. We all have to do more. Hold me accountable.”

Laurie would comment months later that the supervisor’s stirring words at the protest hadn’t prompted any change as far as she could tell.

“Our children are sick,” Jacqui Berlinn said at the protest. “And they need help.”

Laurie didn’t know it as she held the sign at that protest, but Jessica had seen her — and she had bolted. Jessica went to visit Adam at the Deli Board, and he phoned to let me know she was there. He didn’t tell Laurie because Jessica wasn’t ready to see her, but she agreed to talk to me and a Chronicle photographer and have her life documented.

Jessica sat on the curb, smoking a cigarette and downing soda. She had one of the posters with her face on it that her mom had posted, but it was ripped in half.

“What is the extreme of her moving here to this f—ing city with nothing? What the hell?” she said of her mom. “She’s loopy. She’s like mental.”

Laurie Steves’ cell phone shows a photo of her three children, Jessica, Zachary and Lauren. Gabrielle Lurie / The Chronicle

While Jessica seemed annoyed with her mom, she also sometimes flashed a huge smile and peppered our conversation with witty remarks and jokes. A lover of wigs, jewelry and big sunglasses, Jessica could have been a stage actress in another life.

Her hands and ankles were swollen. She showed me a brochure from the San Francisco AIDS Foundation called “How to prevent and respond to overdose.” It had information about how to use Narcan, but nothing about how to get help if you want to stop using drugs.

Jessica said the drugs help mask her intense anxiety and that treatment programs were too structured to work for her. She recalled the first time she used fentanyl — sometime in 2019 when she thought she was buying pure crack cocaine.

“I felt it going up my spine. I felt like it exploded and then I died,” she said. “The feeling of the near-death experience is undescribable. Complete nothingness.”

She said police officers spotted her passed out near the Civic Center BART Station and injected her with Narcan eight times. She survived, and she kept using fentanyl, an incredibly powerful synthetic opioid that’s cheaper, easier to obtain and far more powerful than heroin. Pharmaceutical companies in the 1990s pushed opioids as painkillers that they claimed weren’t addictive, and many people who used pills then switched to heroin and later fentanyl, fueling a national crisis of addiction and death.

“I’ve OD’d at least 50 times,” Jessica said.

Jessica DiDia looks at her needle, which isn’t properly registering into her arm, as she shoots crystal meth with friend Rasool (right) on Turk Street. Gabrielle Lurie / The Chronicle

Jessica said she doesn’t even get high from fentanyl anymore, but it helps with an intense pain in her left leg that she has refused to let doctors examine because she hates hospitals. She keeps the wound, which smells rancid and oozes pus, wrapped in dirty bandages.

Jessica had mostly lived on the streets for years but was staying at the Monarch, a shelter-in-place hotel on Geary Street, during the pandemic. Free room. Free food. Free drug paraphernalia. She just needed money to buy drugs, she said, and she openly acknowledged she gets that money by swiping goods from Target and reselling them.

The Monarch is one of 25 hotels used by the city during the pandemic to house homeless people. Still, the city seems to have mostly missed the opportunity to coax people living in the hotels and addicted to drugs into treatment. Of the roughly 4,000 people who lived in the hotels at any point in the pandemic, just 10 — one quarter of 1% — moved into residential drug treatment programs, according to a spokesperson for the Department of Homelessness and Supportive Housing.

Nearly half of the 1,500 people living in the hotels during the pandemic were connected to mental health care, drug treatment or medical care, but there’s no data on the outcomes, said Angelica Almeida, director of street-based and justice-involved behavioral health services for the city’s Department of Public Health.

Jessica said her life might seem hard, but it’s actually pretty carefree, and she offered a sweeping explanation of one reason why her mom would face such long odds trying to pull her out of San Francisco.

“The city is way too easy for people with nothing to get by,” she said. “That’s why I’m still here nine years later. You get by with doing drugs and suffer no consequences. I like it here.”

Laurie Steves embraces her daughter Jessica DiDia after spotting her while driving around San Francisco’s Tenderloin. Gabrielle Lurie / The Chronicle

Laurie and Adam stood the next afternoon at the entrance to Victoria Manalo Draves Park on Folsom Street. Jessica had promised Adam she would meet her mom there promptly at 4 p.m., writing the time in Sharpie on her arm. As others walked their dogs and sunbathed in the park, Laurie was clearly anxious. She paced, bit her nails and cried, wiping away tears and explaining she had waited nine years for this moment.

“I thought about how little I need to say,” she said. “I need to just let her talk.”

She waited, talking with Adam. Jessica never showed up.

“If you see her,” she told Adam, “tell her Mommy loves her.”

She walked to her car and sat inside crying.

More than a week later, Laurie still hadn’t heard from her daughter. She drove to the Tenderloin, parked and waited. Finally, she saw her.

“I look to the left and there she was, walking past,” Laurie said. “I was like, ‘Jess!’ She whipped her head around so I knew it was her right away.”

Laurie ran across the street, and Jessica asked what she wanted.

“I said, ‘Is that all I get after nine years?’ ” Laurie said. “I gave her a big hug.”

Laurie Steves and daughter Jessica DiDia meet for the first time in nearly 10 years for lunch at Denny’s on Mission Street in San Francisco. Gabrielle Lurie / The Chronicle

They went to Denny’s, and with a tip, Laurie shelled out more than $50. They spent a few hours together, and Jessica used drugs three times.

There seemed to be the beginning of rapport between them, and when Laurie promised to bring brownies to Jessica the next day, her daughter agreed. But when Laurie returned with the treats, Jessica was nowhere to be found.

That’s how much of the summer went, Laurie embarking on long searches in the Tenderloin for Jessica, but only occasionally finding her. Jessica had a cell phone at one point but didn’t use it. Laurie called the Monarch so often that the front-desk person yelled at her to stop.

They spent time together in mid-June, sitting for hours on a stranger’s front steps, arguing in circles. Laurie wanted Jessica to get her leg treated or go to a methadone clinic. Jessica said she needed an ID to do either, but Laurie couldn’t figure out how to make an appointment at the DMV on her phone.

Jessica DiDia smokes a cigarette with mom Laurie Steves on Ellis Street in the Tenderloin. Gabrielle Lurie / The Chronicle

Laurie told Jessica that day she had some good news — she had gotten a full-time job cooking at Mezli, a Silicon Valley startup. She’d help cook Mediterranean food that would eventually be prepared and served entirely by robots to save on costs. She hoped money wouldn’t be so tight anymore.

Laurie had barely been surviving financially. She had gotten a few parking tickets. The food was outrageously expensive. So was the gas. And the rent. She had found jobs cleaning houses on Craigslist, but her bank account had shrunk to $200. She got free groceries weekly at a Bayview food pantry.

Jessica couldn’t believe her mom wasn’t leaning on the city for help.

Laurie Steves carries a tray of cauliflower to the refrigerator while working at Mezli, a startup food company, in San Mateo. Laurie moved to San Francisco from the Seattle area in an attempt to help her daughter, who is addicted to fentanyl and homeless in the Tenderloin. She had to work multiple jobs to try and stay afloat. Gabrielle Lurie / The Chronicle

“You should get a free hotel room,” Jessica told her. “You moved here with nothing. You’re all proper and s—.”

“I don’t qualify for the same services you do,” Laurie told her.

“Yes you do! Shut up! You think people in hotel rooms don’t have income?” Jessica snapped back.

“We need to take a step in the right direction,” Laurie told her daughter, urging her to pick among the hospital, the clinic or the DMV.

But they didn’t get anywhere. They kept arguing on the stranger’s front steps.

Laurie Steves wheels daughter Jessica DiDia into St. Francis Hospital. Jessica was hit by a car and hurt her knee but never made it beyond the waiting room after getting into a fight with her mother. Gabrielle Lurie / The Chronicle

By the end of July, Laurie realized her quest was pointless. Jessica didn’t want to stop using drugs and didn’t want her mom there. Laurie had suspected as much for weeks, but when she called Jessica to chat on July 31, it finally hit her.

“I said I was getting something to eat, and she said, ‘Well, don’t come here. I don’t want to see you,’ ” Laurie recalled.

They fought about her leg again, and Jessica said, “I don’t want your help.”

Laurie knew it was time to leave.

“I can’t do anything else here,” she said. “I can’t afford to live here, either. It’s killing me. I think I have $4 in my bank until payday.”

Laurie told her boss and her landlord that Aug. 31 would be her last day in the city.

Laurie Steves gets emotional talking about how little progress she has made in helping her daughter Jessica. Gabrielle Lurie / The Chronicle

She couldn’t leave San Francisco without saying goodbye to her daughter. But in her 3½ months in San Francisco, Laurie had seen Jessica fewer than 10 times — her daughter never kept a single date with her.

On Aug. 30, Laurie set out after 9 p.m. to find Jessica and say goodbye. She drove in circles through the Tenderloin, past people stumbling in the middle of traffic. Past people slumped against the sides of buildings. Past a mural that read, “There are 3,500 children in the Tenderloin.”

She slowly drove up and down Willow Street, lowering her window to listen for Jessica’s voice. Tents, bicycle parts and hanging blankets lined the grim stretch like a shantytown. Somebody sat in a wheelchair covered almost entirely with a white blanket like a kid dressed as a ghost at Halloween — except swollen, bloody bare feet emerged from the bottom.

She gave up shortly before midnight.

Laurie Steves packs up her belongings after deciding to move back to the Seattle area. Gabrielle Lurie / The Chronicle

Departure day. Laurie packed up her car and put the big photo of Zachary in the back window. She left the Bayview in midafternoon and swung by the Deli Board to say goodbye to Adam.

Laurie said she wished Jessica would just show up so she didn’t have to search the Tenderloin again.

And just then, Jessica appeared. She pushed a cart laden with plastic shopping bags and purses with security tags still on them, and a black barstool strapped to it.

“She’s here! She’s here!” Laurie squealed.

Jessica said she figured her mom would be gone by then, and she wanted Adam to record a “surprise hello-goodbye message” for Laurie to see on Twitter.

Jessica was in an unusually cheerful mood. She and her mom talked about nothing and everything. Like about how Laurie used to always wear turquoise instead of purple. “You look like Barney now,” Jessica teased.

“Do you know you have a security tag on the back of your pants?” Laurie teased back.

Jessica said she swiped them from Target. They went for $20, but she could resell them for $8, she said. She showed her mom a piece of cardboard, also stolen, with cheap silver rings affixed to it and asked Laurie to choose one. They clinked rings — snakes for Jessica, stars for Laurie.

I asked Jessica when Laurie was out of earshot if she would miss her mom.

“Have I ever? Not really,” she said with another shrug. “Even as a kid I don’t think I ever really registered what it would be like to miss her.”

But when Laurie said she had to get on the road, Jessica asked her to spend one more night. Laurie declined, but offered to take her to the hospital to finally get that leg looked at. Jessica refused.

I asked Jessica if she thought she would ever leave San Francisco.

“It’s like a vortex,” she said. “I want to get out of here. But why the f— would I leave here if I have everything I need given to me?

“It might be enabling or it might be keeping you in a cycle, but at least you can survive,” she continued. “That’s better than a lot of places.”

Laurie Steves makes one last attempt to find Jessica before starting the drive back to Washington. Jessica happened to show up at the Deli Board cafe, where Laurie had stopped to say goodbye to owner Adam Mesnick. Laurie and Jessica are able to have a final conversation and embrace before Laurie leaves S.F. Gabrielle Lurie / The Chronicle

They lingered in front of Laurie’s car, neither one ready to say goodbye. Jessica had to use the bathroom urgently and finally relieved herself behind the next car over. She carried toilet paper with her and playfully tossed the roll over Laurie’s car, the tissue getting stuck in her mom’s windshield wipers.

This wasn’t the ending Laurie envisioned. Laurie had upturned her life for 3½ months, but Jessica’s life remained exactly the same. Yet at least they had spent some time together and Jessica was still alive, a small miracle in this city.

Laurie and Jessica hugged tightly. “Well, good luck to you, sweetie,” Laurie said.

“You, too,” Jessica said.

Laurie set off to cross the Golden Gate Bridge. Her phone routed her through the Tenderloin, past the clutch of dealers yet again. “Adios!” she called defiantly. She drove over the bridge, toilet paper still flapping from her wipers.

She stopped in the Marin Headlands to let a Chronicle photographer out of her car and to say goodbye. And then, for the first time, she saw it — the San Francisco that draws people here from around the world for entirely different reasons than the pull that lured her.

The sun’s golden glow flashed off Salesforce Tower. The Transamerica Pyramid jutted into the blue sky. Sailboats dotted the bay. Laurie gasped at the beauty. “God, look at the city,” she said. “Where’s my camera?”

Laurie took photos, climbed back in her car and kept driving.

Epilogue

When she got back to Tacoma, Wash., Laurie got a room in a nonprofit housing facility for single women who can’t afford market-rate apartments, paying $1,100 a month. She is working as a cook in a restaurant, making $18 an hour plus tips. 

Jessica got kicked out of the Monarch hotel and said it was because she didn’t keep the room clean. A spokesperson for the city’s homeless department said she couldn’t comment on Jessica’s case, but the only reasons for eviction from a shelter-in-place hotel are violence, threats of violence, weapons or major property destruction. 

 On Nov. 15, Laurie flew to San Francisco for two days to see Jessica. She found her on Hyde Street, picking a scrap of foil off the sidewalk to see if it had any fentanyl residue on it. They chatted for a while until Jessica told her she didn’t want to go anywhere, make any plan with her mom or do anything different than stay right there on that sidewalk. They hugged, told each other “I love you” and parted ways once again.

Jessica DiDia smokes crack on Eddy Street after her mom moved back to Washington, having failed to get Jessica to agree to get help. Gabrielle Lurie / The Chronicle

The post She got down to save her daughter from fentanyl. She had no concept what she would face on the streets of San Francisco appeared first on Los Gatos News And Events.

SAN FRANCISCO (KPIX 5) – On Wednesday, the mother of a man struggling with addiction protested at an infamous corner in San Francisco’s tenderloin.

She said she was ready to stand alone on the corner. As it turned out, that wouldn’t be necessary.

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“I used to be ashamed,” Jackquie Berlinn told the crowd. “I’m just hiding my story out of shame. I realized a few years ago that it wasn’t helping me. It didn’t help my son. And it didn’t help anyone on the street. “

Berlinn’s son is addicted to fentanyl. He’s on the street in San Francisco somewhere. Desperate, she came to Turk and Hyde to ask for help.

“I’ve spoken to parents who are in other states,” she says. “Your kids come to San Francisco because they know how easy it is to use and get drugs.”

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It is a crisis that a coalition of the Disgruntled is building, and many of them have surfaced today. It was a gathering of residents and politicians who often disagreed on many things. On this issue, they share the frustration.

“Every single officer-elected, supervisor, there are two here, should be here,” Supervisor Matt Haney shouted. “The mayor should be here. The prosecutor should be here. “

“We need bipartisan participation,” said Adam Mesnick. “We need the leaders who admit that addiction is a problem.”

It was vented and argued, but everyone here agreed that the status quo has failed and that there is an impetus for a change towards compassion and accountability.

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“We can offer them services and do everything we can to keep them from drug trafficking in the future,” said Thomas Wolf, an attorney for recovery. “But we need to impose meaningful sanctions, which means we need our district attorney’s cooperation.”

The post Fentanyl Addict’s Mom Leads Rally in San Francisco’s Tenderloin – CBS San Francisco appeared first on Los Gatos News And Events.