Why San Francisco has gone rogue to slow drug overdoses

When people engage in illegal activities, they often try to hide it.

That was the case in San Francisco, where city officials have been quietly running a website on safe drug use for months — in violation of state and federal law.

The mysterious Tenderloin Center, as it’s known, includes a fenced-in patio obscured by tarps blocking part of a public plaza across the street from a new Whole Foods. Here, the city with ineffective Swiss cheese secret has allowed addicts to do drugs while publicly evading the truth.

Media were blocked despite repeated requests. Direct questions about whether guests were allowed to use drugs were answered in a tongue-in-cheek manner, with quick redirects to a variety of other available services in the adjacent building. drugs? Let’s talk about housing!

Those walls collapsed on Thursday when journalists, including myself, were let in even though the center was closed and there wasn’t much to see.

It was a long overdue acknowledgment that the City by the Bay had gone rogue in its fight against a rising number of drug overdose deaths — 38 in that neighborhood alone from January through April.

Though the stealth around the center fueled suspicion and misinformation (and boosted at least one political campaign based on a return to lockdown policies), it’s long past time California got serious about stopping overdose deaths — even if it did means asking for forgiveness rather than permission.

Good job San Francisco – with courage if not with candor.

Vitka Eisen, the executive director of Healthright 360, a nonprofit that oversees overdose prevention, told me (nervously) that up to 200 people come every day to use illegal drugs they brought with them without buying anything or sell is allowed. About two-thirds smoke — mostly fentanyl, but also crystal meth and heroin — while the rest inject.

Vitka Eisen, President and CEO of Healthright 360.

Vitka Eisen, president and chief executive officer of Healthright 360, a healthcare provider serving very low-income and marginalized Californians, holds up a box of the anti-overdose drug Narcan at the Tenderloin Center Thursday.

(Anita Chabria / Los Angeles Times)

More than 100,000 people died from drug overdoses in the US last year, nearly 30% more than the year before. That’s one person every five minutes dying from a cause so easy to avoid, it usually just takes a few squirts of the nasal drug Narcan, which Tenderloin Center staff wear and have stacked around the facility with it others can ingest and use it on the street. Since the center opened in January, 92 overdoses have been reversed so far. That’s 92 non-dead people who survived another day of addiction to maybe, just possibly, start recovery tomorrow.

The state legislature is considering a bill that would legalize the facility in San Francisco and allow Los Angeles and Oakland to open as well. But the fate of the measure is uncertain in an election year when tough talk is on crime and debate over government-sanctioned drug use is heated. The center has become ground zero in the debate about how we should deal with addiction, with one conservative gubernatorial candidate, Michael Shellenberger, reportedly going so far as to jump over the fence.

Critics, including Shellenberger, are calling the center and surrounding area an open-air drug market that has added to the chaos of an already troubled neighborhood. They also claim that it boils down to perpetuating addiction, effectively condoning use over abstinence.

I’ll take the second part of it first.

Shaun “Chuky-G” McKnight was dizzy and desperate for fentanyl when I met him at the door before the center opened. Unable to enter, he smoked a lime-green nugget of fentanyl mixed with meth that was left on the sidewalk. It smoldered into a cloud of smoke that was carried by the wind and slapped my face.

Shante Luster and Shaun "Chuky G" McKnight waits in line to enter the Tenderloin Center.

Shante Luster and Shaun “Chuky-G” McKnight wait to enter the Tenderloin Center in San Francisco on Thursday.

(Anita Chabria / Los Angeles Times)

“I don’t like doing it on the street in front of kids,” he told me after the physical pain of rehab had worn off and he was able to speak. “It gives them a bad impression that it’s okay when it’s not okay. It’s not okay to do drugs.”

He’d rather be out of sight, he said. McKnight has been using fentanyl lately but has been on drugs “his whole life” and was born with heroin in his system to a mother who gave him up at birth. McKnight, who is white, said he was adopted by a black family in South-Central when he was 3 days old and was once a member of the Crenshaw Mafia Gang. Last year he was run over by a recycling truck while passing out in a nearby alley, leaving a nasty scar running down his leg.

He is an unabashed addict and doesn’t see himself quitting even though he would like to. He was in prison, so the “tough love” of incarceration didn’t keep him clean. As I listened to his story, I couldn’t help but wonder: is it better to let him abuse drugs on the sidewalk or in the center? You can call it addiction support, but the road means an increased risk of death. Either way, he will continue to use it for the foreseeable future.

Which brings us to the lawlessness of the neighborhood. Yes, the tenderloin is chaos and those arriving at the center are chaos.

I got there early in the morning of the tour to find the police waking up a group of a dozen people around the corner, many of whom were sucking up fentanyl smoke through straws as it burned onto tinfoil squares. By the time the tour began and the squad car had departed, the crowd had tripled and were openly crowded onto the federal building’s stairs to buy, sell and use.

When I came out of the center an hour later, about 70 people were queuing up waiting for it to open. San Francisco Department of Health official Erica McGary fought that line with a good-natured patience that included telling almost everyone she met, “I appreciate you,” though I’m not sure she did Has.

McGary called a ride-sharing service for a woman pregnant with her fourth child and arranged for a antenatal exam at the hospital. She ended an argument between a man in a wheelchair and a woman who was lugging her laundry in a blue basket she stole from Ross Dress for Less. She greeted an Asian woman selling cigarettes. She urged a man lying under an umbrella and smoking fentanyl to come inside before turning her attention to another man in a wheelchair whose feet were clearly in need of urgent medical attention. A boy who looked about five sauntered through, following a few yards behind a woman in slippers who paid little attention to him.

It was indeed chaos so bad that San Francisco Mayor London Breed declared a state of emergency in the area for several months in December, leading to the opening of the center and promises of police crackdown. This state of emergency has now expired, but the anarchy has not.

Elgin Rose, the executive director of Code Tenderloin, who managed the center’s logistics, told me it was a misconception that the neighborhood suddenly descended into chaos. Rose, 49, said he had been there since he was young and was homeless until three years ago. The tenderloin has been the tenderloin for a long time, he said.

I worked at this place down the road as a cocktail waitress 25 years ago and got off at 3am and I can tell you he’s right.

Elgin Rose, executive director of Code Tenderloin

Elgin Rose, senior director of Code Tenderloin, an outreach organization, stands in front of the Tenderloin Center, where the homeless and vulnerable can access services and where the city operates an overdose prevention facility.

(Anita Chabria / Los Angeles Times)

It’s been a neighborhood’s last resort for decades — for immigrant families who can’t afford rent elsewhere, for the transgender community who haven’t always been welcome elsewhere, for sex workers, addicts and vulnerable people pushed in by gentrification and stigma increasingly smaller areas.

What has changed is that we are paying more attention to the chaos amid a pandemic that has made almost everything in the world worse, and processing a valid concern about fentanyl and other drugs that are coming onto the market and becoming increasingly dangerous and cheaper will. The Tenderloin Center is an all too easy target for all our fears and apprehensions that not everything is going to hell but is already there.

However, the center will not make anything worse, nor will it solve all our problems. But it can help – both the neighborhood and individuals. Despite wishing we could get people off drugs, especially when it’s about someone we care about, it rarely works.

I recently visited Vancouver, where overdose prevention centers were established decades ago. Talking to people at these Canadian facilities changed my mindset. Yes, it sounds defeatist and cynical to allow people to take deadly drugs without asking anything of them. But the people I met knew they were addicted to something horrific, yet for various and personal reasons were unwilling or unable to change.

The safe places of consumption not only offered an escape from death and the unsanitary and dangerous conditions on the streets. They offered to escape the stigma that weighs on the ugliness of their addiction until there’s no daylight between who they are and what they do. Shame is rarely a long-term motivator.

The Tenderloin Center doesn’t have big numbers on getting people into addiction treatment — 53 people have been referred for substance abuse treatment so far, and there’s no information on the results. But there are people like Rose, McGary and Eisen who really appreciate the humanity and vulnerability of those who come in. This is how relationships are built and change happens.

It’s slow and random – a patch, not a fix. But Rose, who has followed in the footsteps of the people he now helps, knows that every minute he spends trying to get someone to talk to him — even if they’re in the process of injecting themselves with fentanyl — a minute that could lead to changes.

“All I’m asking is that people see hope in that,” he said. “Because there’s not much hope out here.”

https://www.latimes.com/california/story/2022-06-04/san-francisco-fights-drug-overdoses-tenderloin-fentanyl Why San Francisco has gone rogue to slow drug overdoses

Alley Einstein

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