How does San Francisco's drug overdose crisis compare with the rest of the U.S.?

[Buckeye Native 001]

Originally Posted by mrnyc

well by the map above its clear that by far most of the sf opioid od problem is in the notorious tenderloin where the poors are kept and where you would expect it. i would bet its more spread out around hamilton county and that would be tougher to deal with.

I know San Francisco has a myriad of issues, but on a very base level, I can't help but think this kind of problem is easier to address, at least in theory, because there's not nearly as many levels and divisions of bureaucracy in the city and county compared to Hamilton County, where not only are there several different cities competing with each other for resources and assistance, but also things like townships and villages.

Again, that grossly simplifies the issue, and there's a whole lot of bureaucratic problems that even consolidated governments face. I was in Cincinnati and Columbus a few weeks back and my dad and I (both of us are municipal government employees) observed how difficult it is to provide services when everything is divided up amongst townships, towns, cities and villages within counties, compared to just cities and counties.

[Pedestrian]

Originally Posted by dktshb

Yeah, I just finished reading it. I do believe though that the Meth and Heroine of the 21st century mixed with fentanyl is the problem and until that is solved more and more people are going to become homeless and a basic mental case.

I think people are confusing 2 issues. Fentanyl is so potent it can be easily overdosed and when it is mixed with drugs whose users don't expect that potency, it can be and is being responsible for a lot of deaths among addicts.

HOWEVER, I don't think you can blame it for the number of addicts or for homelessness. First of all, I'm not sure there are really more addicts than there were, say a decade or two ago, at least in cities like those on the West Coast with large and visible homeless problems. What there is, though, is more visibility and, I would argue, though I expect many to disagree, more tolerance for public misbehavior (not just living on the street but using drugs openly there, relieving ones bladder and bowels there, petty crime and so much more).

But to the extent there really are more addicts, I'd argue that has more to do with the availability of oral opiates like Oxycontin than with fentanyl. I've personally taken histories of their addiction from hundreds of addicts and nearly all started either with pills or smoking drugs like heroin. Then, when they no longer got a satisfactory high, they moved on to injection or seeking out something stronger and that would be fentanyl. As the article I began the thread with says, on the West Coast, a substantial number of addicts using fentanyl actual seek it out. And to the extent, when they are still not injecting their drugs, the heroin they are using is laced with some fentanyl (but not too much), or they can get fentanyl they know to be fentanyl, it could boost the experience enough to delay the move to injection which is kind of the point of no return for many. By that time they are long since addicted but as long as they aren't injecting, they can avoid some of the worst physical harm from opiates (mainly infections of all sorts).

[Pedestrian]

Originally Posted by Buckeye Native 001

I know San Francisco has a myriad of issues, but on a very base level, I can't help but think this kind of problem is easier to address, at least in theory, because there's not nearly as many levels and divisions of bureaucracy in the city and county compared to Hamilton County, where not only are there several different cities competing with each other for resources and assistance, but also things like townships and villages.

Again, that grossly simplifies the issue, and there's a whole lot of bureaucratic problems that even consolidated governments face. I was in Cincinnati and Columbus a few weeks back and my dad and I (both of us are municipal government employees) observed how difficult it is to provide services when everything is divided up amongst townships, towns, cities and villages within counties, compared to just cities and counties.

Like I said above, San Francisco provides almost every type of service anyone can think of and has the money to do it (it recently passed a business tax dedicated solely to homeless services). But consider the old saying, "You can lead a horse to water but you can't make him drink." Too many addicts and the seriously mentally ill do not want or cannot accept help. With walk-in detox and even methadone maintenance and/or buprenorphine being offered, they won't walk in. Although the left argues the one thing the homeless aren't being offered is housing, because its so expensive to build or acquire in the Bay Area, it is not rare for the chronic homeless to get into some form of housing and then be tossed out for violating rules--or simply refusing the offer of housing because of those rules.

The city also is among the few remaining with a network of city-run neighborhood clinics affiliated with the city-run Zuckerberg San Francisco General Hospital and these clinics can provide mental health services such as refills of anti-psychotic or anti-depression drugs. The one area where the city is generally acknowledged to fall woefully short is inpatient psychiatric beds and it needs to build more (and is taking baby steps to do so however this is held back by civil rights concerns about infringing the right not to be involuntarily institutionalized).

[memester]

Originally Posted by Pedestrian

The "insanely wealthy" city of which you speak in part has the problem it has because it pays what some consider insanely good benefits and provides insanely expensive services to the homeless and other poor within its borders. One of the things it offers is walk-in opiate detox. Does Cincinnati? Even single adult males can get a basic "general assistance" monthly check at the highest rate in CA (the rate is determined by counties), but many of the homeless are either vets and eligible for veterans benefits or mentally ill and eligible for SSI or other benefits also. The problem is they may need help knowing what they can get and SF provides that as well with roving outreach workers and regular benefit "fairs" to explain it all and help with applications.

But none of this--totalling over $600 million per year, seems to work. Even offering housing doesn't work because the housing necessarily comes with minimal rules of decorum and behavior that many don't want to abide by. They are so addicted they'd rather lay around on the sidewalk in a tent and "nod" on opiates.

I have to call out some errors in this post. A) Prop N (Care Not Cash) passed by SF voters in 2002 reduced the cash component in GA to about $100 but paired with assisted living services and housing vouchers. It was implemented in 2004 and was reducing the number of un-housed individuals in the city. The financial crisis of 2008 greatly impacted city tax revenue for two budget cycles (2012) and that was reflected in reductions to the program.
Cuts to the program also coincided with the Tech boom 2.0 that saw SF add more than 100,000 jobs over several years (2012 -2018)while building only4,800 units of housing over the same period. The pressure on housing stock was intense and the highest bidders got the spaces. The massive redevelopments in SOMA, including Mission Bay reduced the areas where marginal residents could find even temporary shelter.
B) The city and county of SF budgets approximately $288 million across multiple programs for the homeless. It is not $600 million, City voters did approve Prop C in 2018 that accessed a tax on corporations and luxury homebuyers to fund construction of affordable housing. It was estimated to raise as much as $300 million each year, It is segregated from the city's general fund. The CA Supreme Court ruled last year it did not violate state requirements for passage of a tax measure. Approximately $500 million was in escrow as of 2021.

[edale]

Originally Posted by mrnyc

well by the map above its clear that by far most of the sf opioid od problem is in the notorious tenderloin where the poors are kept and where you would expect it. i would bet its more spread out around hamilton county and that would be tougher to deal with.

Agreed.

People living in poverty:

SF: 9.5%
Hamilton County: 14.6%
Cincinnati: 23% (!)


SF has a homeless issue, not a poverty issue. While addiction and overdosing is not exclusively tied to poverty, it's certainly a major contributing factor. The problem in Ohio is very widespread-- affecting inner cities, suburbs, and rural areas. Much harder to solve that issue than one primarily affecting homeless people in the Tenderloin. Though as we all know, there is no quick or easy fix for the homeless issues many cities are experiencing these days.

[Pedestrian]

Originally Posted by memester

I have to call out some errors in this post. A) Prop N (Care Not Cash) passed by SF voters in 2002 reduced the cash component in GA to about $100 but paired with assisted living services and housing vouchers. It was implemented in 2004 and was reducing the number of un-housed individuals in the city. The financial crisis of 2008 greatly impacted city tax revenue for two budget cycles (2012) and that was reflected in reductions to the program.
Cuts to the program also coincided with the Tech boom 2.0 that saw SF add more than 100,000 jobs over several years (2012 -2018)while building only4,800 units of housing over the same period. The pressure on housing stock was intense and the highest bidders got the spaces. The massive redevelopments in SOMA, including Mission Bay reduced the areas where marginal residents could find even temporary shelter.
B) The city and county of SF budgets approximately $288 million across multiple programs for the homeless. It is not $600 million, City voters did approve Prop C in 2018 that accessed a tax on corporations and luxury homebuyers to fund construction of affordable housing. It was estimated to raise as much as $300 million each year, It is segregated from the city's general fund. The CA Supreme Court ruled last year it did not violate state requirements for passage of a tax measure. Approximately $500 million was in escrow as of 2021.

I see no conflicts with what I said although I am pretty sure your $288 million figure for homeless services not counting Prop C funds is low (I think the number is over $300 million). That puts the total over $600 million, just as I said. Otherwise, its very close to $600 million.

As for the General Assistance grant, I did not say it was all cash and whether cash or part services, it’s among if not THE most generous in the state (albeit pretty meager which I didn’t say it wasn’t). Finally what niether you nor I previously mentioned is how easy the Bay Area’s mix of many counties in a small geogrphic area reachable by transit makes it for some people to apply for and receive GA in multiple jurisdictions which is, of course, illegal.

[mrnyc]

Originally Posted by edale

Agreed.

People living in poverty:

SF: 9.5%
Hamilton County: 14.6%
Cincinnati: 23% (!)


SF has a homeless issue, not a poverty issue. While addiction and overdosing is not exclusively tied to poverty, it's certainly a major contributing factor. The problem in Ohio is very widespread-- affecting inner cities, suburbs, and rural areas. Much harder to solve that issue than one primarily affecting homeless people in the Tenderloin. Though as we all know, there is no quick or easy fix for the homeless issues many cities are experiencing these days.

well, i dk any rich homeless. maybe there are in sf, but i would doubt it. i would think the druggies collect there because they are in poverty and can get the drugs and services. also, broadly speaking, its california, the world's end magnet in usa lore and the tenderloin collects people who come out there, fall to ruin and have nowhere else to go. that is california's cross to bear, and one that frankly they do not get enough sympathy and support for. otoh, this also makes it harder for hamilton county because its not in the news and in america's conscious all the damn time like sf is.

edit -- come to think of it, i do recall dayton being in the news a few years ago for being the opioid drug death capital of america, but that didn't last long in the news cycle, did it?

[TexasPlaya]

Depressing thread, especially seeing my home country of Harris (Houston) doing so poorly.

I got a job as pharmacy technician in 2009 and we were getting inundated with the “cocktails” of norco, benzo, plus soma. These pill mills would be all cash and these MDs were just making money by the RX.