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"content": "\u003cp>Gov. Gavin Newsom proposed a plan Thursday to offer more services to unhoused people who have severe mental health and substance use disorders, even if that means forcing some to receive that care, a move many advocates of the unhoused consider a blatant violation of civil rights.\u003c/p>\n\u003cp>The governor said at a press conference that he has no intention of rounding people up and locking them away. Instead, he said his plan would offer a way for people to get court-ordered psychiatric treatment, medication and housing, preferably before they are arrested.\u003c/p>\n\u003cp>[pullquote align=\"right\" size=\"medium\" citation=\"Gov. Gavin Newsom\"]‘There’s no compassion stepping over people in the streets and sidewalks. We could hold hands, have a candlelight vigil, talk about the way the world should be, or we could take some damn responsibility to implement our ideals, and that’s what we’re doing differently here.’[/pullquote]Under the plan, which requires approval by the Legislature, all counties would have to set up a mental health branch in civil court and provide comprehensive and community-based treatment to those suffering from debilitating psychosis. People need not be homeless to be evaluated by a court.\u003c/p>\n\u003cp>But if approved, unhoused people facing criminal charges would be obligated to accept the care or risk adjudication. Those not facing charges, but deemed in need of care, would be potentially forced into psychiatric programs or lengthier conservatorships, in which a court authorizes other adults to make health and legal decisions for them.\u003c/p>\n\u003cp>“There’s no compassion stepping over people in the streets and sidewalks,” Newsom told reporters during the briefing, staged at a mental health treatment facility in San José. “We could hold hands, have a candlelight vigil, talk about the way the world should be, or we could take some damn responsibility to implement our ideals, and that’s what we’re doing differently here.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Newsom, the former mayor of San Francisco, has made homelessness and housing a focus of his administration. Last year, the Legislature approved $12 billion for new housing and treatment beds for the unhoused, and this year Newsom has proposed an additional $2 billion primarily to shelter people suffering from psychosis, schizophrenia and behavioral health disorders.\u003c/p>\n\u003cp>The governor’s office plans to boost the program with more money for psychologists, treatment beds and services, although officials did not provide an estimate of how much it might cost.\u003c/p>\n\u003cp>Newsom has frequently referred to distressing behavior that’s become increasingly common on the streets in some California cities, calling it heartbreaking and maddening and saying residents are right to complain that government is not doing enough.\u003c/p>\n\u003cp>People with addiction issues or mental health disorders \u003ca href=\"https://apnews.com/article/lifestyle-health-arrests-only-on-ap-81d7a75c445a73709ff31e12d99583ce\">often pinball among various\u003c/a> public agencies, namely hospitals, courts and jails. There is rarely one single place that manages someone’s health and offers steady and safe housing, combined with resource-intensive care.\u003c/p>\n\u003cp>California, like the rest of the country, suffers from a severe shortage of treatment beds.\u003c/p>\n\u003cp>“One of the most heartbreaking, heart-wrenching and yet curable challenges that we face … is how do we serve the needs of individuals who are the sickest of the sick?” Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said in advance of Newsom’s announcement.\u003c/p>\n\u003cp>Ghaly said he expects the program, called Care Court, to apply to as many as 12,000 people in California, not all of whom need to be unhoused.\u003c/p>\n\u003cp>Compare that to just over 200 people forced into court-ordered treatment last year under Laura’s Law, a state program for people with severe and persistent mental illness who may pose a risk to themselves or others, he said. The program is optional, and just over half of California’s 58 counties participate.\u003c/p>\n\u003cp>The governor said that, under his proposal, those in need would have a say in their treatment plan and have a public defender to represent them. Most importantly, the proposal allows a broader array of people, including family members, outreach workers and first responders, to refer the person for help, he said. Care could last up to 24 months.[aside label=\"Related Coverage\" tag=\"homelessness\"]But the idea of forcing people into treatment rattled some civil rights defenders and advocates of the unhoused. Meanwhile, the California State Association of Counties quickly objected to the requirements, citing the burden it would place on individual counties.\u003c/p>\n\u003cp>“At this point there are a million questions and a million things that could go horribly wrong,” said Kevin Baker, director of government relations for ACLU California Action, in an email. He said homelessness is caused by skyrocketing housing costs “and we won’t solve homelessness, mental health, or substance abuse problems by locking people up and drugging them against their will.”\u003c/p>\n\u003cp>The Western Center on Law and Poverty pointed to a 2020 state audit that found many people put under conservatorship wound up with limited treatment and follow-up.\u003c/p>\n\u003cp>“Forcing people into temporary hospitalization will not help individuals move out of homelessness when there are not enough services or housing units to begin with,” it said in a statement.\u003c/p>\n\u003cp>Still, others contend that mandated treatment is necessary for some who are too sick to realize they need care.\u003c/p>\n\u003cp>In San Francisco, a state law designed to get more people into conservatorships has resulted in just two people being forced into care, said Rafael Mandelman, a city supervisor, describing how he has watched helplessly as unhoused residents languish outdoors.\u003c/p>\n\u003cp>Mandelman says he would welcome more money for emergency psychiatric treatment beds and staffing. But he says there also needs to be a major change in both the deployment of resources and in the way judges think.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We also clearly need better systems that are able to respond to the needs of this population much better,” he said, “and we need laws that are clear to judges, and that reflect the expectations of the community.”\u003c/p>\n\n",
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"excerpt": "The plan would offer more services to unhoused people who have severe mental health and substance use disorders, but could also compel certain individuals to receive that care, a move some advocates consider a civil rights violation.\r\n",
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"title": "Newsom Proposes Offering More Treatment Services for Unhoused People — and Forcing Some to Participate | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Gov. Gavin Newsom proposed a plan Thursday to offer more services to unhoused people who have severe mental health and substance use disorders, even if that means forcing some to receive that care, a move many advocates of the unhoused consider a blatant violation of civil rights.\u003c/p>\n\u003cp>The governor said at a press conference that he has no intention of rounding people up and locking them away. Instead, he said his plan would offer a way for people to get court-ordered psychiatric treatment, medication and housing, preferably before they are arrested.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Under the plan, which requires approval by the Legislature, all counties would have to set up a mental health branch in civil court and provide comprehensive and community-based treatment to those suffering from debilitating psychosis. People need not be homeless to be evaluated by a court.\u003c/p>\n\u003cp>But if approved, unhoused people facing criminal charges would be obligated to accept the care or risk adjudication. Those not facing charges, but deemed in need of care, would be potentially forced into psychiatric programs or lengthier conservatorships, in which a court authorizes other adults to make health and legal decisions for them.\u003c/p>\n\u003cp>“There’s no compassion stepping over people in the streets and sidewalks,” Newsom told reporters during the briefing, staged at a mental health treatment facility in San José. “We could hold hands, have a candlelight vigil, talk about the way the world should be, or we could take some damn responsibility to implement our ideals, and that’s what we’re doing differently here.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Newsom, the former mayor of San Francisco, has made homelessness and housing a focus of his administration. Last year, the Legislature approved $12 billion for new housing and treatment beds for the unhoused, and this year Newsom has proposed an additional $2 billion primarily to shelter people suffering from psychosis, schizophrenia and behavioral health disorders.\u003c/p>\n\u003cp>The governor’s office plans to boost the program with more money for psychologists, treatment beds and services, although officials did not provide an estimate of how much it might cost.\u003c/p>\n\u003cp>Newsom has frequently referred to distressing behavior that’s become increasingly common on the streets in some California cities, calling it heartbreaking and maddening and saying residents are right to complain that government is not doing enough.\u003c/p>\n\u003cp>People with addiction issues or mental health disorders \u003ca href=\"https://apnews.com/article/lifestyle-health-arrests-only-on-ap-81d7a75c445a73709ff31e12d99583ce\">often pinball among various\u003c/a> public agencies, namely hospitals, courts and jails. There is rarely one single place that manages someone’s health and offers steady and safe housing, combined with resource-intensive care.\u003c/p>\n\u003cp>California, like the rest of the country, suffers from a severe shortage of treatment beds.\u003c/p>\n\u003cp>“One of the most heartbreaking, heart-wrenching and yet curable challenges that we face … is how do we serve the needs of individuals who are the sickest of the sick?” Dr. Mark Ghaly, secretary of the California Health and Human Services Agency, said in advance of Newsom’s announcement.\u003c/p>\n\u003cp>Ghaly said he expects the program, called Care Court, to apply to as many as 12,000 people in California, not all of whom need to be unhoused.\u003c/p>\n\u003cp>Compare that to just over 200 people forced into court-ordered treatment last year under Laura’s Law, a state program for people with severe and persistent mental illness who may pose a risk to themselves or others, he said. The program is optional, and just over half of California’s 58 counties participate.\u003c/p>\n\u003cp>The governor said that, under his proposal, those in need would have a say in their treatment plan and have a public defender to represent them. Most importantly, the proposal allows a broader array of people, including family members, outreach workers and first responders, to refer the person for help, he said. Care could last up to 24 months.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>But the idea of forcing people into treatment rattled some civil rights defenders and advocates of the unhoused. Meanwhile, the California State Association of Counties quickly objected to the requirements, citing the burden it would place on individual counties.\u003c/p>\n\u003cp>“At this point there are a million questions and a million things that could go horribly wrong,” said Kevin Baker, director of government relations for ACLU California Action, in an email. He said homelessness is caused by skyrocketing housing costs “and we won’t solve homelessness, mental health, or substance abuse problems by locking people up and drugging them against their will.”\u003c/p>\n\u003cp>The Western Center on Law and Poverty pointed to a 2020 state audit that found many people put under conservatorship wound up with limited treatment and follow-up.\u003c/p>\n\u003cp>“Forcing people into temporary hospitalization will not help individuals move out of homelessness when there are not enough services or housing units to begin with,” it said in a statement.\u003c/p>\n\u003cp>Still, others contend that mandated treatment is necessary for some who are too sick to realize they need care.\u003c/p>\n\u003cp>In San Francisco, a state law designed to get more people into conservatorships has resulted in just two people being forced into care, said Rafael Mandelman, a city supervisor, describing how he has watched helplessly as unhoused residents languish outdoors.\u003c/p>\n\u003cp>Mandelman says he would welcome more money for emergency psychiatric treatment beds and staffing. But he says there also needs to be a major change in both the deployment of resources and in the way judges think.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>“We also clearly need better systems that are able to respond to the needs of this population much better,” he said, “and we need laws that are clear to judges, and that reflect the expectations of the community.”\u003c/p>\n\n\u003c/div>\u003c/p>",
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"title": "San Francisco's Street Overdose Response Team Is Trying to Bring Clinical Care to the Streets",
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"content": "\u003cp>It’s a sun-filled, fall day and Nicholas is strapped to an ambulance gurney near 8th and Market streets in downtown San Francisco, dazed and barely conscious. Plastic IV tubes snake around his left hand where L-O-V-E is tattooed just below his knuckles.\u003c/p>\n\u003cp>“Nicholas, try to wake up a little bit for me, come on,” paramedic Paula Fartash coaxes, as she unsuccessfully tries to rouse him.\u003c/p>\n\u003cp>Nicholas (we’re not using his last name because of the stigma of addiction) tells Fartash that when he started getting high in nearby U.N. Plaza park, he assumed he was smoking his drug of choice.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“This gentleman thought that he was doing meth,” the veteran San Francisco Fire Department paramedic says. “And turned out he was actually doing fentanyl as well,” the synthetic opioid many times more powerful than heroin. “So he walked over to someone and they gave him some Narcan.”\u003c/p>\n\u003cp>That’s the brand name for naloxone, the emergency nasal spray drug used to try to reverse an otherwise potentially fatal overdose. That someone who administered a life-saving antidote was a nearby volunteer and street cleaner carrying Narcan, \u003ca href=\"https://harmreduction.org/our-work/action/dope-project-san-francisco/\">part of a city-supported program\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11895057\" class=\"wp-caption alignnone\" style=\"max-width: 1224px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895057 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-9.jpg\" alt=\"The inside of an ambulance, where only the arm and tattooed hand and a bit of the torso of someone who is receiving care is visible. The person receiving care has many tattoos.\" width=\"1224\" height=\"816\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9.jpg 1224w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9-160x107.jpg 160w\" sizes=\"auto, (max-width: 1224px) 100vw, 1224px\">\u003cfigcaption class=\"wp-caption-text\">A man named Nicholas gets care in an ambulance after overdosing in San Francisco’s Civic Center. He told members of the emergency response team that when he started getting high, he assumed he was smoking meth. However, it turned out that he was unknowingly consuming fentanyl as well. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>San Francisco has among the highest per capita drug overdose death rates of any city in the U.S.\u003c/h3>\n\u003cp>Faced with a stunning rise in drug overdose deaths the last few years, the vast majority tied to fentanyl, San Francisco has launched mobile teams made up of paramedics and nurses. The new Street Overdose Response Team (SORT), a collaboration between the city’s health and fire departments, aims to deliver a broad range of support and care directly following an overdose.[aside postID=\"news_11890421\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/fentanylteststrips_annelisefinney-1020x765.jpg\"]“Fentanyl is a game changer,” \u003ca href=\"https://sfmayor.org/article/mayor-london-breed-announces-new-director-behavioral-health-services-and-mental-health-sf\">Dr. Hillary Kunins\u003c/a>, the city’s director of behavioral and mental health services, says of the opioid that’s 80 to 100 times stronger than morphine. “It requires a new way of thinking and resourcing.” It also, she says, “requires people to learn to work across disciplines and sometimes across organizations.”\u003c/p>\n\u003cp>Kunins previously led New York City’s response to its overdose and substance abuse crisis. She concedes they aren’t sure what combination of tools, ultimately, will work best here to not only reduce fentanyl- and other drug-related deaths but also to boost treatment success rates.\u003c/p>\n\u003cp>So the street overdose pilot project is part of a broad and ambitious strategy of interventions across city agencies.\u003c/p>\n\u003cp>“There is no single approach that’s going to solve this complex problem,” Kunins says. “What’s exciting and important about the work is that it is really part of a movement across the country to rethink how we address people who are at risk of overdose, who have ongoing other challenges: mental health, housing, food. And we must do this work to scale.”\u003c/p>\n\u003ch3>\u003cstrong>Fentanyl forced city officials to change how they approached harm reduction\u003c/strong>\u003c/h3>\n\u003cp>Capt. Michael Mason, a paramedic, is the fire department’s point person on the new program. As he races to the call for Nicholas’s overdose, he’s simultaneously coordinating with other paramedics.\u003c/p>\n\u003cp>“So starting directly at the scene of this overdose, we can start trying to direct this guy’s care in the best direction possible,” Mason says.[aside postID=\"news_11874651\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2021/05/RS48996_006_MountainView_RobinDosskey_05122021-qut.jpg\"]That direct engagement could include helping to find a shelter bed, reaching out to friends or a doctor, helping with food or, most importantly, seeing if a person wants to start treatment with buprenorphine or suboxone, a medication-assisted therapy for opioid dependence.\u003c/p>\n\u003cp>“Get this individual suboxone, stabilize him at the [emergency department], by that afternoon they can be in a treatment program,” Mason says, “All in the context of a 911 incident.”\u003c/p>\n\u003cp>For many years San Francisco has championed a harm-reduction public health approach to lowering drug deaths and injury. The city, known for its relative tolerance of illicit drug use, was a trailblazer of clean syringe access and distribution of life-saving naloxone kits, as well as boosting access to the treatment drugs methadone and buprenorphine.\u003c/p>\n\u003cp>But when fentanyl hit hard here starting a few years ago, the overdose crisis spiraled and the city was forced to rethink its approach. Free Narcan and syringes weren’t enough.\u003c/p>\n\u003cp>“If fentanyl is in the drugs that you’re using, your risk of overdose triples,” Capt. Mason says, adding that the drug is now tainting most every street narcotic here: meth, cocaine, heroin and fake opioid pills.\u003c/p>\n\u003cfigure id=\"attachment_11895039\" class=\"wp-caption alignnone\" style=\"max-width: 1228px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895039 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-3.jpg\" alt=\"A person knocks on the front door of an apartment on the second, outdoor floor of a multistory building.\" width=\"1228\" height=\"920\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3.jpg 1228w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3-800x599.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3-1020x764.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3-160x120.jpg 160w\" sizes=\"auto, (max-width: 1228px) 100vw, 1228px\">\u003cfigcaption class=\"wp-caption-text\">San Francisco Department of Public Health nurses with the city’s new mobile outreach teams say following up with people who’ve recently survived a drug overdose is a key part of the program. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Surviving an overdose\u003c/h3>\n\u003cp>Pandemic isolation and lockdowns — people using alone with no one to administer life-saving Narcan — only partially explain the historic rise in overdose deaths here.\u003c/p>\n\u003cp>The \u003ca href=\"https://sf.gov/resource/2020/ocme-accidental-overdose-reports\">drug death rate, in fact, had been trending higher\u003c/a> well before that, city medical examiner data show. In mid-2018 the numbers began to skyrocket, reaching 441 deaths in 2019. And in 2020, \u003ca href=\"https://sf.gov/data/covid-19-cases-and-deaths#total-cases-and-deaths\">a whopping 712 people fatally overdosed\u003c/a>, more than double the number of people here who died from COVID-19 during that same period.\u003c/p>\n\u003cp>The vast majority of those deaths — almost three-quarters —involved fentanyl.\u003c/p>\n\u003cp>The death toll would have been even higher if not for \u003ca href=\"https://harmreduction.org/our-work/action/dope-project-san-francisco/\">the wide availability of Narcan here\u003c/a>. Well over 3,000 people said they used Narcan in the city in 2020, a self-reported figure. Officials say the real figure is probably far higher.\u003c/p>\n\u003cp>But health and fire department officials here, Mason says, noticed something else important: Almost half of all who died of an overdose were treated or revived by a paramedic crew in the days or weeks before their deaths, a big signal they were headed for repeat trouble.\u003c/p>\n\u003cp>“Surviving a nonfatal overdose is one of the best predictors of future mortality. Anyone who survives a nonfatal overdose is a huge red flag for us, and that is what this program is about,” he says.\u003c/p>\n\u003cp>A key goal is trying to bring the clinic to the patients: rapid, face-to-face follow-up outreach on the street.\u003c/p>\n\u003cp>“We go out, we look for them, we say, ‘Hey, let’s talk about yesterday,'” says city health department nurse practitioner Kevin Lagor, as he drives through the Tenderloin neighborhood, where many of his clients live. He’s a program lead with SORT’s outreach arm.\u003c/p>\n\u003cp>The goal is to reach back out within 24 to 72 hours of an overdose to try to assist the person with everything from housing to treatment.\u003c/p>\n\u003cp>“That could be providing medical care to address their mental illness. Maybe they’re out of their meds, or maybe they want to start something to address their substance use disorder,” he says. “Just kind of, basically, meeting them where they are and seeing what they need and how we can help them.”\u003c/p>\n\u003cp>But to meet them where they are, the nurse teams first have to find them.\u003c/p>\n\u003cp>It’s a huge challenge. Many of them are unhoused, living in tents on the street or in and out of shelters.\u003c/p>\n\u003cp>The overdose and substance use disorder crisis is directly linked to the city’s epic struggles with homelessness and related challenges including mental illness. Almost 30% of all overdose deaths here are among people experiencing homelessness or people “with no fixed address.” \u003ca href=\"https://www.npr.org/2020/10/19/924146486/removing-cops-from-behavioral-crisis-calls-we-need-to-change-the-model\">SORT collaborates closely with the city’s other programs\u003c/a>, including street medicine and new mental health and homeless street crisis response units.\u003c/p>\n\u003cfigure id=\"attachment_11895030\" class=\"wp-caption aligncenter\" style=\"max-width: 1224px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895030 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-5.jpg\" alt=\"A person stands in the middle of a crosswalk looking up the street and at a row of tents on each sidewalk.\" width=\"1224\" height=\"918\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5.jpg 1224w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5-160x120.jpg 160w\" sizes=\"auto, (max-width: 1224px) 100vw, 1224px\">\u003cfigcaption class=\"wp-caption-text\">People live in tents that line a side street in the Tenderloin District. More than 40% of all drug overdoses are in the Tenderloin and neighboring SoMa districts, according to city data. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>City data shows that men were almost four times more likely to die of an accidental overdose than women. And unhoused people, older San Franciscans and communities of color were disproportionately affected by the death rate: Almost a quarter of all overdose deaths were among Black San Franciscans, who make up just under 6% of the city’s population.\u003c/p>\n\u003cp>More than 40% of all overdose deaths in the last year have been concentrated in two neighborhoods: the South of Market area and the Tenderloin, according to data from the city and county chief medical examiner’s office. Those areas make up just 7% of the city’s population.\u003c/p>\n\u003cp>While drug deaths hit every sector of society, many who overdosed were found in city-funded hotel rooms for unhoused residents and in apartment buildings for those with low incomes.\u003c/p>\n\u003cp>“We have to remember that this is a social crisis at the intersection, particularly in San Francisco, of a housing crisis, of a mental health crisis, of people living at the margins of society,” says Dr. Dan Ciccarone, a professor and researcher at University of California, San Francisco.\u003c/p>\n\u003cp>Open-air drug use and dealing in the Tenderloin, an area long challenged by poverty, homelessness and addiction crises, has only worsened during the pandemic. It’s common, day or night, to see people smoking or shooting up opioids or nodding out from drug use.\u003c/p>\n\u003cp>One 32-year-old man named Neil (we’re not using his last name because of the stigma of addiction) says he’s been living on the streets, mainly in the Tenderloin, for three years now.\u003c/p>\n\u003cp>He says he uses fentanyl “to take the edge off” of his depression and chronic stomach pain. He occasionally sells drugs, he says, to get money to support his habit. He soon crushes a small amount of fentanyl into a piece of tinfoil and begins to smoke the drug.\u003c/p>\n\u003cfigure id=\"attachment_11895055\" class=\"wp-caption alignnone\" style=\"max-width: 1229px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895055 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-6.jpg\" alt=\"Two people wearing face masks stand outside a white van parked alongside a mural as they look through papers and plastic bags in their hands. It looks like early morning.\" width=\"1229\" height=\"921\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6.jpg 1229w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6-1020x764.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6-160x120.jpg 160w\" sizes=\"auto, (max-width: 1229px) 100vw, 1229px\">\u003cfigcaption class=\"wp-caption-text\">City public health department nurses Kevin Lagor and Louise Bisby, part of new mobile outreach teams, get supplies out of their SUV to bring to people who have recently survived a drug overdose. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Follow-up work by nurses is full of challenges\u003c/h3>\n\u003cp>On a recent day, nurse Lagor has half a dozen clients listed on his clipboard. He can’t find a single person.\u003c/p>\n\u003cp>“So we’ll just kind of keep following up with the staff at the shelter,” he says in the lobby of one facility, having been unable to find a client.\u003c/p>\n\u003cp>The same happens at a makeshift tent encampment behind a local Best Buy.\u003c/p>\n\u003cp>Outside another shelter, Lagor and his team strike out again trying to find a young man they thought they were making progress with. They’d recently written him a prescription for a supply of buprenorphine.\u003c/p>\n\u003cp>“He hasn’t been here in a couple of days,” Lagor says, disappointed.\u003c/p>\n\u003cp>“It is a bad sign. Sometimes folks disappear for a couple days and then resurface,” he says. “Then they disappear, or it just falls apart.”\u003c/p>\n\u003cp>And when it all falls apart, it can hit Lagor and the rest of his team hard.\u003c/p>\n\u003cp>“It’s a lot of death and they’re not strangers. You know, we’ve had a couple of deaths this week and we’ve, we shed tears together,” Lagor says. “It’s hard not to care about someone when you’re really trying to help them.”\u003c/p>\n\u003cp>Addiction and public health experts say these mobile, nonpolice teams mark a much-needed pivot for the city.\u003c/p>\n\u003cp>“It’s bold and it’s innovative. I like it,” says Ciccarone, a professor of medicine at UC San Francisco and a leading expert on drug use, people who use drugs and heroin. “We need to bring in some innovations here because fentanyl is a wild card and it has caught us all by surprise. That’s what we need to do in a crisis situation: Think creatively.”\u003c/p>\n\u003cp>But Ciccarone cautions that the ravages of fentanyl and its complex stew of related challenges mean the city needs to scale up this new street overdose response program and continue to try to break down obstacles to treatment that include bureaucratic silos, turf battles and funding woes.\u003c/p>\n\u003cp>“It’s definitely not enough,” he says. “We have to make sure that harm reduction is adequately funded, that our mental health system, our substance treatment system, our housing systems are adequately funded.”\u003c/p>\n\u003cp>So far, just two months since the program’s launch, 10% of those encountered by the SORT teams who’ve overdosed are now getting medication-assisted treatment for opioid use disorder. That includes buprenorphine or suboxone in collaboration with city’s street medicine nurses.\u003c/p>\n\u003cp>“I’m proud of that number,” Capt. Mason says, “and I very much look forward to increasing that.”\u003c/p>\n\u003cp>To get that number even higher, the fire department has applied to the state EMS agency to allow paramedics to more easily administer and prescribe those treatment drugs directly in the field.\u003c/p>\n\u003cp>Despite a recent slight drop in monthly fatalities the city looks to end 2021 with \u003ca href=\"https://sf.gov/sites/default/files/2021-10/2021%2010_OCME%20Overdose%20Report.pdf\">more than 700 overdose deaths for the second year in a row.\u003c/a> Unfortunately, Kunins, the city’s director of behavioral health services, says San Francisco is “on track to continue this really tragic loss of life.”\u003c/p>\n\u003cfigure id=\"attachment_11895040\" class=\"wp-caption alignnone\" style=\"max-width: 1224px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895040 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-8.jpg\" alt=\"A uniformed man in black pants, black boots, and a white short-sleeved shirt with a red-and-yellow insignia sewn on the sleeve opens the back door of an ambulance parked in the middle of a street.\" width=\"1224\" height=\"918\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8.jpg 1224w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8-160x120.jpg 160w\" sizes=\"auto, (max-width: 1224px) 100vw, 1224px\">\u003cfigcaption class=\"wp-caption-text\">Fire Department Capt. Michael Mason with the city’s Street Overdose Response Team arrives at the scene of a reported drug overdose in downtown San Francisco. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Paramedics on the team look for small victories\u003c/h3>\n\u003cp>Back on the street, another call comes in from the 911 dispatcher for a possible overdose. A middle-aged woman has been found slumped over in a McDonald’s bathroom across town in the Fillmore district.\u003c/p>\n\u003cp>Capt. Mason’s occasional staccato siren squawks aren’t working on a handful of drivers and pedestrians in heavy rush-hour traffic. So he hits his lights and sirens full bore.\u003c/p>\n\u003cp>When they arrive, the woman tells the paramedics she has relapsed after several months of sobriety.\u003c/p>\n\u003cp>The heroin she bought, Mason says, was likely laced with fentanyl. Narcan saved her.\u003c/p>\n\u003cp>Inside the ambulance, Mason says, the woman handed paramedics a crumpled, greasy brown fast-food bag and asked that they get rid of it.\u003c/p>\n\u003cp>“There were some clean syringes in there and what appeared to be small bags of heroin,” he says.\u003c/p>\n\u003cp>Mason finds out she was already part of a medication-assisted treatment program using suboxone. He says she told them that she wants to get sober again.\u003c/p>\n\u003cp>“She was feeling extreme shame from experiencing a relapse,” he says. “Substance use disorder impacts millions of Americans. There’s no shame in having a relapse.”\u003c/p>\n\u003cp>He hopes she restarts her suboxone treatment quickly.\u003c/p>\n\u003cp>“As for today,” Mason says, “and as for surrendering those items and requesting they be disposed of, my hat’s off to her.”\u003c/p>\n\u003cp>The paramedics and nurses involved in this pilot project are dedicated to this difficult work. But all say working across multiple city agencies, treatment centers, health providers and nonprofits can be exhausting.\u003c/p>\n\u003cp>“It’s complicated,” Mason says with a sigh, “it takes work from dozens of folks in a single encounter.”\u003c/p>\n\u003cp>How does he handle the strain of 12-hour shifts filled racing from overdose to overdose, including to some who seemingly don’t want help and others who don’t survive?\u003c/p>\n\u003cp>“For my own mental health, I have to kind of remain an optimistic warrior,” he says, driving his fire department pickup through rush hour traffic. “There’s a quote in the Talmud that says — I won’t get it exactly right — but essentially says, ‘You don’t have to end this work, but you do have to start it.'”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "Facing an unprecedented increase in overdose deaths, specifically due to fentanyl, emergency response teams in San Francisco are working together to offer a broad range of support directly following an overdose.",
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"title": "San Francisco's Street Overdose Response Team Is Trying to Bring Clinical Care to the Streets | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>It’s a sun-filled, fall day and Nicholas is strapped to an ambulance gurney near 8th and Market streets in downtown San Francisco, dazed and barely conscious. Plastic IV tubes snake around his left hand where L-O-V-E is tattooed just below his knuckles.\u003c/p>\n\u003cp>“Nicholas, try to wake up a little bit for me, come on,” paramedic Paula Fartash coaxes, as she unsuccessfully tries to rouse him.\u003c/p>\n\u003cp>Nicholas (we’re not using his last name because of the stigma of addiction) tells Fartash that when he started getting high in nearby U.N. Plaza park, he assumed he was smoking his drug of choice.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“This gentleman thought that he was doing meth,” the veteran San Francisco Fire Department paramedic says. “And turned out he was actually doing fentanyl as well,” the synthetic opioid many times more powerful than heroin. “So he walked over to someone and they gave him some Narcan.”\u003c/p>\n\u003cp>That’s the brand name for naloxone, the emergency nasal spray drug used to try to reverse an otherwise potentially fatal overdose. That someone who administered a life-saving antidote was a nearby volunteer and street cleaner carrying Narcan, \u003ca href=\"https://harmreduction.org/our-work/action/dope-project-san-francisco/\">part of a city-supported program\u003c/a>.\u003c/p>\n\u003cfigure id=\"attachment_11895057\" class=\"wp-caption alignnone\" style=\"max-width: 1224px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895057 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-9.jpg\" alt=\"The inside of an ambulance, where only the arm and tattooed hand and a bit of the torso of someone who is receiving care is visible. The person receiving care has many tattoos.\" width=\"1224\" height=\"816\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9.jpg 1224w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-9-160x107.jpg 160w\" sizes=\"auto, (max-width: 1224px) 100vw, 1224px\">\u003cfigcaption class=\"wp-caption-text\">A man named Nicholas gets care in an ambulance after overdosing in San Francisco’s Civic Center. He told members of the emergency response team that when he started getting high, he assumed he was smoking meth. However, it turned out that he was unknowingly consuming fentanyl as well. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>San Francisco has among the highest per capita drug overdose death rates of any city in the U.S.\u003c/h3>\n\u003cp>Faced with a stunning rise in drug overdose deaths the last few years, the vast majority tied to fentanyl, San Francisco has launched mobile teams made up of paramedics and nurses. The new Street Overdose Response Team (SORT), a collaboration between the city’s health and fire departments, aims to deliver a broad range of support and care directly following an overdose.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“Fentanyl is a game changer,” \u003ca href=\"https://sfmayor.org/article/mayor-london-breed-announces-new-director-behavioral-health-services-and-mental-health-sf\">Dr. Hillary Kunins\u003c/a>, the city’s director of behavioral and mental health services, says of the opioid that’s 80 to 100 times stronger than morphine. “It requires a new way of thinking and resourcing.” It also, she says, “requires people to learn to work across disciplines and sometimes across organizations.”\u003c/p>\n\u003cp>Kunins previously led New York City’s response to its overdose and substance abuse crisis. She concedes they aren’t sure what combination of tools, ultimately, will work best here to not only reduce fentanyl- and other drug-related deaths but also to boost treatment success rates.\u003c/p>\n\u003cp>So the street overdose pilot project is part of a broad and ambitious strategy of interventions across city agencies.\u003c/p>\n\u003cp>“There is no single approach that’s going to solve this complex problem,” Kunins says. “What’s exciting and important about the work is that it is really part of a movement across the country to rethink how we address people who are at risk of overdose, who have ongoing other challenges: mental health, housing, food. And we must do this work to scale.”\u003c/p>\n\u003ch3>\u003cstrong>Fentanyl forced city officials to change how they approached harm reduction\u003c/strong>\u003c/h3>\n\u003cp>Capt. Michael Mason, a paramedic, is the fire department’s point person on the new program. As he races to the call for Nicholas’s overdose, he’s simultaneously coordinating with other paramedics.\u003c/p>\n\u003cp>“So starting directly at the scene of this overdose, we can start trying to direct this guy’s care in the best direction possible,” Mason says.\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>That direct engagement could include helping to find a shelter bed, reaching out to friends or a doctor, helping with food or, most importantly, seeing if a person wants to start treatment with buprenorphine or suboxone, a medication-assisted therapy for opioid dependence.\u003c/p>\n\u003cp>“Get this individual suboxone, stabilize him at the [emergency department], by that afternoon they can be in a treatment program,” Mason says, “All in the context of a 911 incident.”\u003c/p>\n\u003cp>For many years San Francisco has championed a harm-reduction public health approach to lowering drug deaths and injury. The city, known for its relative tolerance of illicit drug use, was a trailblazer of clean syringe access and distribution of life-saving naloxone kits, as well as boosting access to the treatment drugs methadone and buprenorphine.\u003c/p>\n\u003cp>But when fentanyl hit hard here starting a few years ago, the overdose crisis spiraled and the city was forced to rethink its approach. Free Narcan and syringes weren’t enough.\u003c/p>\n\u003cp>“If fentanyl is in the drugs that you’re using, your risk of overdose triples,” Capt. Mason says, adding that the drug is now tainting most every street narcotic here: meth, cocaine, heroin and fake opioid pills.\u003c/p>\n\u003cfigure id=\"attachment_11895039\" class=\"wp-caption alignnone\" style=\"max-width: 1228px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895039 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-3.jpg\" alt=\"A person knocks on the front door of an apartment on the second, outdoor floor of a multistory building.\" width=\"1228\" height=\"920\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3.jpg 1228w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3-800x599.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3-1020x764.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-3-160x120.jpg 160w\" sizes=\"auto, (max-width: 1228px) 100vw, 1228px\">\u003cfigcaption class=\"wp-caption-text\">San Francisco Department of Public Health nurses with the city’s new mobile outreach teams say following up with people who’ve recently survived a drug overdose is a key part of the program. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Surviving an overdose\u003c/h3>\n\u003cp>Pandemic isolation and lockdowns — people using alone with no one to administer life-saving Narcan — only partially explain the historic rise in overdose deaths here.\u003c/p>\n\u003cp>The \u003ca href=\"https://sf.gov/resource/2020/ocme-accidental-overdose-reports\">drug death rate, in fact, had been trending higher\u003c/a> well before that, city medical examiner data show. In mid-2018 the numbers began to skyrocket, reaching 441 deaths in 2019. And in 2020, \u003ca href=\"https://sf.gov/data/covid-19-cases-and-deaths#total-cases-and-deaths\">a whopping 712 people fatally overdosed\u003c/a>, more than double the number of people here who died from COVID-19 during that same period.\u003c/p>\n\u003cp>The vast majority of those deaths — almost three-quarters —involved fentanyl.\u003c/p>\n\u003cp>The death toll would have been even higher if not for \u003ca href=\"https://harmreduction.org/our-work/action/dope-project-san-francisco/\">the wide availability of Narcan here\u003c/a>. Well over 3,000 people said they used Narcan in the city in 2020, a self-reported figure. Officials say the real figure is probably far higher.\u003c/p>\n\u003cp>But health and fire department officials here, Mason says, noticed something else important: Almost half of all who died of an overdose were treated or revived by a paramedic crew in the days or weeks before their deaths, a big signal they were headed for repeat trouble.\u003c/p>\n\u003cp>“Surviving a nonfatal overdose is one of the best predictors of future mortality. Anyone who survives a nonfatal overdose is a huge red flag for us, and that is what this program is about,” he says.\u003c/p>\n\u003cp>A key goal is trying to bring the clinic to the patients: rapid, face-to-face follow-up outreach on the street.\u003c/p>\n\u003cp>“We go out, we look for them, we say, ‘Hey, let’s talk about yesterday,'” says city health department nurse practitioner Kevin Lagor, as he drives through the Tenderloin neighborhood, where many of his clients live. He’s a program lead with SORT’s outreach arm.\u003c/p>\n\u003cp>The goal is to reach back out within 24 to 72 hours of an overdose to try to assist the person with everything from housing to treatment.\u003c/p>\n\u003cp>“That could be providing medical care to address their mental illness. Maybe they’re out of their meds, or maybe they want to start something to address their substance use disorder,” he says. “Just kind of, basically, meeting them where they are and seeing what they need and how we can help them.”\u003c/p>\n\u003cp>But to meet them where they are, the nurse teams first have to find them.\u003c/p>\n\u003cp>It’s a huge challenge. Many of them are unhoused, living in tents on the street or in and out of shelters.\u003c/p>\n\u003cp>The overdose and substance use disorder crisis is directly linked to the city’s epic struggles with homelessness and related challenges including mental illness. Almost 30% of all overdose deaths here are among people experiencing homelessness or people “with no fixed address.” \u003ca href=\"https://www.npr.org/2020/10/19/924146486/removing-cops-from-behavioral-crisis-calls-we-need-to-change-the-model\">SORT collaborates closely with the city’s other programs\u003c/a>, including street medicine and new mental health and homeless street crisis response units.\u003c/p>\n\u003cfigure id=\"attachment_11895030\" class=\"wp-caption aligncenter\" style=\"max-width: 1224px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895030 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-5.jpg\" alt=\"A person stands in the middle of a crosswalk looking up the street and at a row of tents on each sidewalk.\" width=\"1224\" height=\"918\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5.jpg 1224w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-5-160x120.jpg 160w\" sizes=\"auto, (max-width: 1224px) 100vw, 1224px\">\u003cfigcaption class=\"wp-caption-text\">People live in tents that line a side street in the Tenderloin District. More than 40% of all drug overdoses are in the Tenderloin and neighboring SoMa districts, according to city data. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>City data shows that men were almost four times more likely to die of an accidental overdose than women. And unhoused people, older San Franciscans and communities of color were disproportionately affected by the death rate: Almost a quarter of all overdose deaths were among Black San Franciscans, who make up just under 6% of the city’s population.\u003c/p>\n\u003cp>More than 40% of all overdose deaths in the last year have been concentrated in two neighborhoods: the South of Market area and the Tenderloin, according to data from the city and county chief medical examiner’s office. Those areas make up just 7% of the city’s population.\u003c/p>\n\u003cp>While drug deaths hit every sector of society, many who overdosed were found in city-funded hotel rooms for unhoused residents and in apartment buildings for those with low incomes.\u003c/p>\n\u003cp>“We have to remember that this is a social crisis at the intersection, particularly in San Francisco, of a housing crisis, of a mental health crisis, of people living at the margins of society,” says Dr. Dan Ciccarone, a professor and researcher at University of California, San Francisco.\u003c/p>\n\u003cp>Open-air drug use and dealing in the Tenderloin, an area long challenged by poverty, homelessness and addiction crises, has only worsened during the pandemic. It’s common, day or night, to see people smoking or shooting up opioids or nodding out from drug use.\u003c/p>\n\u003cp>One 32-year-old man named Neil (we’re not using his last name because of the stigma of addiction) says he’s been living on the streets, mainly in the Tenderloin, for three years now.\u003c/p>\n\u003cp>He says he uses fentanyl “to take the edge off” of his depression and chronic stomach pain. He occasionally sells drugs, he says, to get money to support his habit. He soon crushes a small amount of fentanyl into a piece of tinfoil and begins to smoke the drug.\u003c/p>\n\u003cfigure id=\"attachment_11895055\" class=\"wp-caption alignnone\" style=\"max-width: 1229px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895055 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-6.jpg\" alt=\"Two people wearing face masks stand outside a white van parked alongside a mural as they look through papers and plastic bags in their hands. It looks like early morning.\" width=\"1229\" height=\"921\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6.jpg 1229w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6-1020x764.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-6-160x120.jpg 160w\" sizes=\"auto, (max-width: 1229px) 100vw, 1229px\">\u003cfigcaption class=\"wp-caption-text\">City public health department nurses Kevin Lagor and Louise Bisby, part of new mobile outreach teams, get supplies out of their SUV to bring to people who have recently survived a drug overdose. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Follow-up work by nurses is full of challenges\u003c/h3>\n\u003cp>On a recent day, nurse Lagor has half a dozen clients listed on his clipboard. He can’t find a single person.\u003c/p>\n\u003cp>“So we’ll just kind of keep following up with the staff at the shelter,” he says in the lobby of one facility, having been unable to find a client.\u003c/p>\n\u003cp>The same happens at a makeshift tent encampment behind a local Best Buy.\u003c/p>\n\u003cp>Outside another shelter, Lagor and his team strike out again trying to find a young man they thought they were making progress with. They’d recently written him a prescription for a supply of buprenorphine.\u003c/p>\n\u003cp>“He hasn’t been here in a couple of days,” Lagor says, disappointed.\u003c/p>\n\u003cp>“It is a bad sign. Sometimes folks disappear for a couple days and then resurface,” he says. “Then they disappear, or it just falls apart.”\u003c/p>\n\u003cp>And when it all falls apart, it can hit Lagor and the rest of his team hard.\u003c/p>\n\u003cp>“It’s a lot of death and they’re not strangers. You know, we’ve had a couple of deaths this week and we’ve, we shed tears together,” Lagor says. “It’s hard not to care about someone when you’re really trying to help them.”\u003c/p>\n\u003cp>Addiction and public health experts say these mobile, nonpolice teams mark a much-needed pivot for the city.\u003c/p>\n\u003cp>“It’s bold and it’s innovative. I like it,” says Ciccarone, a professor of medicine at UC San Francisco and a leading expert on drug use, people who use drugs and heroin. “We need to bring in some innovations here because fentanyl is a wild card and it has caught us all by surprise. That’s what we need to do in a crisis situation: Think creatively.”\u003c/p>\n\u003cp>But Ciccarone cautions that the ravages of fentanyl and its complex stew of related challenges mean the city needs to scale up this new street overdose response program and continue to try to break down obstacles to treatment that include bureaucratic silos, turf battles and funding woes.\u003c/p>\n\u003cp>“It’s definitely not enough,” he says. “We have to make sure that harm reduction is adequately funded, that our mental health system, our substance treatment system, our housing systems are adequately funded.”\u003c/p>\n\u003cp>So far, just two months since the program’s launch, 10% of those encountered by the SORT teams who’ve overdosed are now getting medication-assisted treatment for opioid use disorder. That includes buprenorphine or suboxone in collaboration with city’s street medicine nurses.\u003c/p>\n\u003cp>“I’m proud of that number,” Capt. Mason says, “and I very much look forward to increasing that.”\u003c/p>\n\u003cp>To get that number even higher, the fire department has applied to the state EMS agency to allow paramedics to more easily administer and prescribe those treatment drugs directly in the field.\u003c/p>\n\u003cp>Despite a recent slight drop in monthly fatalities the city looks to end 2021 with \u003ca href=\"https://sf.gov/sites/default/files/2021-10/2021%2010_OCME%20Overdose%20Report.pdf\">more than 700 overdose deaths for the second year in a row.\u003c/a> Unfortunately, Kunins, the city’s director of behavioral health services, says San Francisco is “on track to continue this really tragic loss of life.”\u003c/p>\n\u003cfigure id=\"attachment_11895040\" class=\"wp-caption alignnone\" style=\"max-width: 1224px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11895040 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/11/NPR-fentanyl-8.jpg\" alt=\"A uniformed man in black pants, black boots, and a white short-sleeved shirt with a red-and-yellow insignia sewn on the sleeve opens the back door of an ambulance parked in the middle of a street.\" width=\"1224\" height=\"918\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8.jpg 1224w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/11/NPR-fentanyl-8-160x120.jpg 160w\" sizes=\"auto, (max-width: 1224px) 100vw, 1224px\">\u003cfigcaption class=\"wp-caption-text\">Fire Department Capt. Michael Mason with the city’s Street Overdose Response Team arrives at the scene of a reported drug overdose in downtown San Francisco. \u003ccite>(Rachel Bujalski for NPR)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>Paramedics on the team look for small victories\u003c/h3>\n\u003cp>Back on the street, another call comes in from the 911 dispatcher for a possible overdose. A middle-aged woman has been found slumped over in a McDonald’s bathroom across town in the Fillmore district.\u003c/p>\n\u003cp>Capt. Mason’s occasional staccato siren squawks aren’t working on a handful of drivers and pedestrians in heavy rush-hour traffic. So he hits his lights and sirens full bore.\u003c/p>\n\u003cp>When they arrive, the woman tells the paramedics she has relapsed after several months of sobriety.\u003c/p>\n\u003cp>The heroin she bought, Mason says, was likely laced with fentanyl. Narcan saved her.\u003c/p>\n\u003cp>Inside the ambulance, Mason says, the woman handed paramedics a crumpled, greasy brown fast-food bag and asked that they get rid of it.\u003c/p>\n\u003cp>“There were some clean syringes in there and what appeared to be small bags of heroin,” he says.\u003c/p>\n\u003cp>Mason finds out she was already part of a medication-assisted treatment program using suboxone. He says she told them that she wants to get sober again.\u003c/p>\n\u003cp>“She was feeling extreme shame from experiencing a relapse,” he says. “Substance use disorder impacts millions of Americans. There’s no shame in having a relapse.”\u003c/p>\n\u003cp>He hopes she restarts her suboxone treatment quickly.\u003c/p>\n\u003cp>“As for today,” Mason says, “and as for surrendering those items and requesting they be disposed of, my hat’s off to her.”\u003c/p>\n\u003cp>The paramedics and nurses involved in this pilot project are dedicated to this difficult work. But all say working across multiple city agencies, treatment centers, health providers and nonprofits can be exhausting.\u003c/p>\n\u003cp>“It’s complicated,” Mason says with a sigh, “it takes work from dozens of folks in a single encounter.”\u003c/p>\n\u003cp>How does he handle the strain of 12-hour shifts filled racing from overdose to overdose, including to some who seemingly don’t want help and others who don’t survive?\u003c/p>\n\u003cp>“For my own mental health, I have to kind of remain an optimistic warrior,” he says, driving his fire department pickup through rush hour traffic. “There’s a quote in the Talmud that says — I won’t get it exactly right — but essentially says, ‘You don’t have to end this work, but you do have to start it.'”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"slug": "what-do-you-need-from-us-california-caregivers-trailblaze-solutions-for-people-who-use-deadly-drugs",
"title": "Asking People What They Need: California Caregivers Trailblaze Solutions for Those Dealing with Addiction",
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"headTitle": "Asking People What They Need: California Caregivers Trailblaze Solutions for Those Dealing with Addiction | KQED",
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"content": "\u003cp>\u003cem>Jump to resources:\u003c/em>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"#support\">\u003cstrong>Where to find support for substance abuse disorder\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>In this episode of The California Report Magazine, health reporters Lesley McClurg and April Dembosky take us inside hospitals and clinics to meet people dealing with substance addiction who are getting help in new ways. For the first time, doctors and caregivers are asking: What do you need from us?\u003c/em>\u003c/p>\n\u003cp>Last year more than 93,000 people died of drug overdoses nationwide, more than 10,000 of them in California. The public health crisis, which has spiked during COVID, is taking a horrific toll on communities and cities across the state.\u003c/p>\n\u003cp>For decades the state’s approach has been to punish people who do drugs. But it hasn’t worked.\u003c/p>\n\u003cp>“It’s more than a failure, it has been incredibly harmful,” said Dr. Monish Ullal, internal medicine physician and associate medical director of the Bridge clinic at Highland Hospital. “I think the war on drugs is one of the most disappointing things that our country has done in the last 30 years.”\u003c/p>\n\u003cp>Now policymakers are switching gears by recognizing addiction as a disease needing medical attention. California is investing large amounts of money in new models of treatment for those dealing with substance addiction. Two new programs are showing promise, and becoming models for the rest of the country.\u003c/p>\n\u003cfigure id=\"attachment_11891410\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11891410\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Bridge Founding Member and Director of Harm Reduction Services Joshua Luftig speaks with a patient about Narcan at the Bridge substance use program at Highland Hospital in Oakland on Oct. 6, 2021 . \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003cb>Emergency rooms anchor recovery efforts\u003c/b>\u003c/h3>\n\u003cp>The first initiative is called \u003ca href=\"https://cabridge.org/\">CA Bridge\u003c/a>, and its goal is to initiate treatment for patients with a substance use disorder in the emergency department. It may be hard to believe, but treating substance addiction within a hospital is fairly recent strategy.\u003c/p>\n\u003cp>The program has a two-pronged approach. First, emergency medical physicians are trained to dispense medication to treat opioid use. Once a patient is stable, they are assigned a counselor or “substance use navigator” to ensure a strong hand-off to long-term treatment once they leave the ER.\u003c/p>\n\u003cfigure id=\"attachment_11891415\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891415 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg\" alt=\"A woman with long hair, glasses, a mask, and a floral shirt points at a clipboard, which a doctor in blue scrubs and a mask looks at.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Substance Use Manager Monique Randolph speaks with a doctor at the Saint Francis Emergency Department in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Just letting them know it’s OK. We got you,” explained Christian Hailozian, a substance use navigator at Highland Hospital. “That extra kind of hand-holding that these patients need to really start that journey of recovery.”\u003c/p>\n\u003cp>[aside postID=\"news_11854373\" hero=\"https://ww2.kqed.org/app/uploads/sites/10/2019/02/Rick-Andrews-at-SF-AIDS-Foundation-1020x678.jpg\"]The pilot program, which started at eight California hospitals, worked so well that the state invested another $20 million last fall to expand the California Bridge model. Now 144, or about 40% of hospitals across the state, have staffed a substance use navigator. The goal is to enroll all remaining hospitals by 2025.\u003c/p>\n\u003cp>The other big initiative is a new treatment for addiction to methamphetamine or cocaine. While there are three FDA-approved medications available to treat opioid use disorder — the cornerstone of the Bridge program — there are none for stimulants.\u003c/p>\n\u003cp>“There’s a lot of hopelessness in the community using stimulants, a lot less belief that treatment will help them,” said Dr. Kelly Pfeifer, deputy director of behavioral health at the California Department of Health Care Services.\u003c/p>\n\u003cfigure id=\"attachment_11890594\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11890594\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg\" alt=\"A man in sunglasses and a hat stands beneath a Pride flag outside a Victorian with a sign that says Castro Country Club.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Billy Lemon, 50, kicked his meth habit more than nine years ago after taking part in a ‘contingency management’ program for meth and cocaine users at the San Francisco AIDS Foundation. For every negative drug test, he earned a small amount of money. Lemon now runs the Castro Country Club, a recovery center in San Francisco. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2021/09/methamphetamine-involved-overdose-deaths-nearly-tripled-between-2015-to-2019-nih-study-finds\">Meth-related overdoses have tripled nationwide\u003c/a> in recent years, and treatment providers are desperate to find something that works.\u003c/p>\n\u003cp>Providers have landed on a behavioral treatment that studies show is highly effective, but has been only narrowly deployed: \u003ca href=\"https://www.kqed.org/news/11854373/state-lawmakers-move-to-expand-effective-but-controversial-treatment-for-meth-addiction\">contingency management\u003c/a>, an incentive therapy that uses money or prizes to encourage people who use drugs not to use them.\u003c/p>\n\u003cp>California is betting big on contingency management. Lawmakers passed a bill that would authorize the state’s Medi-Cal program to offer the treatment. It’s awaiting Gov. Gavin Newsom’s signature, and state health officials also have requested permission from the federal government to provide the therapy to hundreds of thousands of Californians in lower-income households.\u003c/p>\n\u003cfigure id=\"attachment_11891417\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891417 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg\" alt='A person wearing scrubs and a face mask moves through a door, next to a letterboard sign saying \"Welcome to the Bridge.\"' width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Christian Hailozian, substance use navigator and program coordinator, walks out of the Bridge substance use program office at Highland Hospital in Oakland on Oct. 6, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003ca id=\"support\">\u003c/a>Where to find support for substance abuse disorder\u003c/h3>\n\u003cul>\n\u003cli>If you are insured through Medi-Cal, you can access your county’s \u003cstrong>substance abuse disorder county access line\u003c/strong>. The resources offered vary by county. \u003ca href=\"https://www.dhcs.ca.gov/individuals/Pages/SUD_County_Access_Lines.aspx\">Find the list of phone numbers here.\u003c/a>\u003c/li>\n\u003cli>Most California counties participate in the \u003cstrong>Drug Medi-Cal Organized Delivery System\u003c/strong>, a 2015 expansion that provides more alcohol and drug use services to people in need. \u003ca href=\"https://choosechangeca.org/?campaign=print\">Get more information on how to access treatment for an opioid addiction here.\u003c/a>\u003c/li>\n\u003cli>The \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/\">\u003cstrong>San Francisco AIDS Foundation\u003c/strong>\u003c/a> offers a variety of initiatives that center harm reduction to support those dealing with substance addiction. This includes support for \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/cocaine-crack-use-support/\">cocaine and crack use\u003c/a>, \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/meth-use-support/\">meth use\u003c/a> and \u003ca href=\"https://www.sfaf.org/services/syringe-access-disposal/\">safe syringe disposal sites\u003c/a>.\u003c/li>\n\u003cli>Finding support for mental illness can sometimes be part of dealing with substance abuse. NAMI is the \u003cstrong>National Alliance on Mental Illness\u003c/strong>, and several counties have their own chapter. \u003ca href=\"https://namica.org/find-your-local-nami\">Find the closest one to you here.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://cabridge.org/tools/resources/\">Providers wanting to learn how to make \u003cstrong>CA Bridge\u003c/strong> part of your work can learn more here.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n",
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"excerpt": "Across the state, providers are now expanding efforts to offer one-stop help at the ER and pay people to not consume drugs. ",
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"title": "Asking People What They Need: California Caregivers Trailblaze Solutions for Those Dealing with Addiction | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>Jump to resources:\u003c/em>\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"#support\">\u003cstrong>Where to find support for substance abuse disorder\u003c/strong>\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003cem>In this episode of The California Report Magazine, health reporters Lesley McClurg and April Dembosky take us inside hospitals and clinics to meet people dealing with substance addiction who are getting help in new ways. For the first time, doctors and caregivers are asking: What do you need from us?\u003c/em>\u003c/p>\n\u003cp>Last year more than 93,000 people died of drug overdoses nationwide, more than 10,000 of them in California. The public health crisis, which has spiked during COVID, is taking a horrific toll on communities and cities across the state.\u003c/p>\n\u003cp>For decades the state’s approach has been to punish people who do drugs. But it hasn’t worked.\u003c/p>\n\u003cp>“It’s more than a failure, it has been incredibly harmful,” said Dr. Monish Ullal, internal medicine physician and associate medical director of the Bridge clinic at Highland Hospital. “I think the war on drugs is one of the most disappointing things that our country has done in the last 30 years.”\u003c/p>\n\u003cp>Now policymakers are switching gears by recognizing addiction as a disease needing medical attention. California is investing large amounts of money in new models of treatment for those dealing with substance addiction. Two new programs are showing promise, and becoming models for the rest of the country.\u003c/p>\n\u003cfigure id=\"attachment_11891410\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11891410\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg\" alt=\"\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51782_024_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">California Bridge Founding Member and Director of Harm Reduction Services Joshua Luftig speaks with a patient about Narcan at the Bridge substance use program at Highland Hospital in Oakland on Oct. 6, 2021 . \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003cb>Emergency rooms anchor recovery efforts\u003c/b>\u003c/h3>\n\u003cp>The first initiative is called \u003ca href=\"https://cabridge.org/\">CA Bridge\u003c/a>, and its goal is to initiate treatment for patients with a substance use disorder in the emergency department. It may be hard to believe, but treating substance addiction within a hospital is fairly recent strategy.\u003c/p>\n\u003cp>The program has a two-pronged approach. First, emergency medical physicians are trained to dispense medication to treat opioid use. Once a patient is stable, they are assigned a counselor or “substance use navigator” to ensure a strong hand-off to long-term treatment once they leave the ER.\u003c/p>\n\u003cfigure id=\"attachment_11891415\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891415 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg\" alt=\"A woman with long hair, glasses, a mask, and a floral shirt points at a clipboard, which a doctor in blue scrubs and a mask looks at.\" width=\"800\" height=\"533\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut-1536x1024.jpg 1536w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51209_005_SanFrancisco_StFrancisER_08262021-qut.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Substance Use Manager Monique Randolph speaks with a doctor at the Saint Francis Emergency Department in San Francisco on Aug. 26, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>“Just letting them know it’s OK. We got you,” explained Christian Hailozian, a substance use navigator at Highland Hospital. “That extra kind of hand-holding that these patients need to really start that journey of recovery.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>The pilot program, which started at eight California hospitals, worked so well that the state invested another $20 million last fall to expand the California Bridge model. Now 144, or about 40% of hospitals across the state, have staffed a substance use navigator. The goal is to enroll all remaining hospitals by 2025.\u003c/p>\n\u003cp>The other big initiative is a new treatment for addiction to methamphetamine or cocaine. While there are three FDA-approved medications available to treat opioid use disorder — the cornerstone of the Bridge program — there are none for stimulants.\u003c/p>\n\u003cp>“There’s a lot of hopelessness in the community using stimulants, a lot less belief that treatment will help them,” said Dr. Kelly Pfeifer, deputy director of behavioral health at the California Department of Health Care Services.\u003c/p>\n\u003cfigure id=\"attachment_11890594\" class=\"wp-caption alignnone\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-11890594\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg\" alt=\"A man in sunglasses and a hat stands beneath a Pride flag outside a Victorian with a sign that says Castro Country Club.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Billy Lemon, 50, kicked his meth habit more than nine years ago after taking part in a ‘contingency management’ program for meth and cocaine users at the San Francisco AIDS Foundation. For every negative drug test, he earned a small amount of money. Lemon now runs the Castro Country Club, a recovery center in San Francisco. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2021/09/methamphetamine-involved-overdose-deaths-nearly-tripled-between-2015-to-2019-nih-study-finds\">Meth-related overdoses have tripled nationwide\u003c/a> in recent years, and treatment providers are desperate to find something that works.\u003c/p>\n\u003cp>Providers have landed on a behavioral treatment that studies show is highly effective, but has been only narrowly deployed: \u003ca href=\"https://www.kqed.org/news/11854373/state-lawmakers-move-to-expand-effective-but-controversial-treatment-for-meth-addiction\">contingency management\u003c/a>, an incentive therapy that uses money or prizes to encourage people who use drugs not to use them.\u003c/p>\n\u003cp>California is betting big on contingency management. Lawmakers passed a bill that would authorize the state’s Medi-Cal program to offer the treatment. It’s awaiting Gov. Gavin Newsom’s signature, and state health officials also have requested permission from the federal government to provide the therapy to hundreds of thousands of Californians in lower-income households.\u003c/p>\n\u003cfigure id=\"attachment_11891417\" class=\"wp-caption alignnone\" style=\"max-width: 1920px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11891417 size-full\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg\" alt='A person wearing scrubs and a face mask moves through a door, next to a letterboard sign saying \"Welcome to the Bridge.\"' width=\"1920\" height=\"1280\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut.jpg 1920w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/10/RS51766_007_Oakland_HighlandHospitalBridgeProgram_10062021-qut-1536x1024.jpg 1536w\" sizes=\"(max-width: 1920px) 100vw, 1920px\">\u003cfigcaption class=\"wp-caption-text\">Christian Hailozian, substance use navigator and program coordinator, walks out of the Bridge substance use program office at Highland Hospital in Oakland on Oct. 6, 2021. \u003ccite>(Beth LeBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003ch3>\u003ca id=\"support\">\u003c/a>Where to find support for substance abuse disorder\u003c/h3>\n\u003cul>\n\u003cli>If you are insured through Medi-Cal, you can access your county’s \u003cstrong>substance abuse disorder county access line\u003c/strong>. The resources offered vary by county. \u003ca href=\"https://www.dhcs.ca.gov/individuals/Pages/SUD_County_Access_Lines.aspx\">Find the list of phone numbers here.\u003c/a>\u003c/li>\n\u003cli>Most California counties participate in the \u003cstrong>Drug Medi-Cal Organized Delivery System\u003c/strong>, a 2015 expansion that provides more alcohol and drug use services to people in need. \u003ca href=\"https://choosechangeca.org/?campaign=print\">Get more information on how to access treatment for an opioid addiction here.\u003c/a>\u003c/li>\n\u003cli>The \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/\">\u003cstrong>San Francisco AIDS Foundation\u003c/strong>\u003c/a> offers a variety of initiatives that center harm reduction to support those dealing with substance addiction. This includes support for \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/cocaine-crack-use-support/\">cocaine and crack use\u003c/a>, \u003ca href=\"https://www.sfaf.org/services/substance-use-treatment/meth-use-support/\">meth use\u003c/a> and \u003ca href=\"https://www.sfaf.org/services/syringe-access-disposal/\">safe syringe disposal sites\u003c/a>.\u003c/li>\n\u003cli>Finding support for mental illness can sometimes be part of dealing with substance abuse. NAMI is the \u003cstrong>National Alliance on Mental Illness\u003c/strong>, and several counties have their own chapter. \u003ca href=\"https://namica.org/find-your-local-nami\">Find the closest one to you here.\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"https://cabridge.org/tools/resources/\">Providers wanting to learn how to make \u003cstrong>CA Bridge\u003c/strong> part of your work can learn more here.\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "California May Be First State to Try Treatment That Pays People Not to Use Meth",
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"content": "\u003cp>\u003cem>This is an updated version of a post that originally published on Jan. 8, 2021.\u003c/em>\u003c/p>\n\u003cp>When Billy Lemon was trying to kick his methamphetamine addiction, he went to a drug treatment program at the \u003ca href=\"https://www.sfaf.org/programs/stonewall-project/positive-reinforcement-opportunity-project-prop/\">San Francisco AIDS Foundation\u003c/a> three times a week and peed in a cup. If it tested negative for meth, he got paid about $7.\u003c/p>\n\u003cp>“For somebody who had not had any legitimate money — without committing felonies — that seemed like a cool thing,” says Lemon, who was arrested three times for selling meth before starting recovery.\u003c/p>\n\u003cp>The payments were part of an addiction treatment called contingency management, which incentivizes people who use drugs with money or gift cards to stay off drugs. At the end of 12 weeks, after all his drug tests came back negative for meth, Lemon received $330. But for him, it was about more than just the money. It was being told: Good job.\u003c/p>\n\u003cp>“It was the first opportunity where I was like, I have self-worth still. It’s buried. This person sees it and is willing to give me $7, just to take care of myself. That was very motivating,” he says.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>As overdoses and public health costs related to meth and cocaine use continue to spiral in California, state officials are desperate for more effective treatment options and are pursuing legislation and appealing to federal regulators to make contingency management more widely available. Washington, Montana and West Virginia also are exploring similar strategies.\u003c/p>\n\u003cp>Studies show that contingency management works. The principles of the treatment — positive reinforcement, primarily — are used widely in weight loss, fitness programs and in families, as parents coax their children into adopting positive behaviors, rather than punishing them for negative ones.\u003c/p>\n\u003cp>Research shows \u003ca href=\"https://storage.googleapis.com/plos-corpus-prod/10.1371/journal.pmed.1002715/1/pmed.1002715.pdf?X-Goog-Algorithm=GOOG4-RSA-SHA256&X-Goog-Credential=wombat-sa%40plos-prod.iam.gserviceaccount.com%2F20210929%2Fauto%2Fstorage%2Fgoog4_request&X-Goog-Date=20210929T232600Z&X-Goog-Expires=86400&X-Goog-SignedHeaders=host&X-Goog-Signature=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\">contingency management is the most effective treatment for meth or cocaine addiction\u003c/a>, especially when combined with other behavioral therapy. At the San Francisco AIDS Foundation, 63% of people who participated in the program in 2019 stopped using meth entirely, and another 19% reduced their use.\u003c/p>\n\u003cfigure id=\"attachment_11890594\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11890594 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg\" alt=\"A man in sunglasses and a hat stands beneath a Pride flag outside a Victorian with a sign that says Castro Country Club.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Billy Lemon, 50, kicked his meth habit more than nine years ago after taking part in a ‘contingency management’ program for people who use meth and cocaine at the San Francisco AIDS Foundation. For every negative drug test, he earned a small amount of money. Lemon now runs the Castro Country Club, a recovery center in San Francisco. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Department of Veterans Affairs has relied on the therapy to treat 5,600 vets over the last 10 years. Of the 73,000 urine samples collected in the VA program, 92% tested negative for drugs, according to \u003ca href=\"https://blogs.va.gov/VAntage/64870/how-va-uses-contingency-management-help-veterans-stay-drug-free/\">Dominick DePhilippis\u003c/a>, a clinical psychologist at the Philadelphia Center of Excellence for Substance Abuse Treatment and Education who helped launch the VA’s program.\u003c/p>\n\u003cp>“Patients often come to treatment ambivalent about change. Why? Because substance use is so seductive. It provides powerful, immediate reinforcement,” DePhilippis says. “Whereas recovery, its immediate consequences, are often unpleasant: withdrawal symptoms, a clear-eyed view of the devastated landscape that is one’s life.”\u003c/p>\n\u003cp>Contingency management embraces this challenge head on, he adds, by offering immediate rewards and reinforcement for abstinence. The small payments or prizes aim to rewire the brain’s reward system, so the person seeks the money or gift card to get a dopamine release, instead of meth or coke.\u003c/p>\n\u003cp>“You’re like, ‘Oh! Oh! I can feel good without the daily use of that substance. Let me try and go one more week,'” says Lemon. “And then all of a sudden, you’re at 90 days and you’ve actually made a change.”\u003c/p>\n\u003cp>Despite its effectiveness, the treatment is controversial. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049167/\">Critics have scoffed at the idea of paying people who use drugs not to use drugs\u003c/a>, calling it unethical or a bribe. Most insurers don’t cover it. Neither do state Medicaid programs. The \u003ca href=\"https://www.healthaffairs.org/do/10.1377/hblog20200305.965186/full/\">feds generally forbid them from offering financial incentives to patients\u003c/a>, as a protection against fraud and waste, and state officials have interpreted that rule as prohibiting reimbursement for contingency management.\u003c/p>\n\u003ch3>California will try to scale up an effective treatment for stimulant addiction\u003c/h3>\n\u003cp>But as the drug epidemic continues to worsen throughout California and the nation, with \u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2021/09/methamphetamine-involved-overdose-deaths-nearly-tripled-between-2015-to-2019-nih-study-finds\">overdoses from stimulants like meth tripling in recent years\u003c/a>, state officials are questioning those policies and pushing for changes. Critics are softening their stance. A bill now on the governor’s desk — \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB110\">Senate Bill 110\u003c/a> — would allow the state’s Medicaid program to pay for contingency management services, with the goal of encouraging more drug treatment centers to offer it.\u003c/p>\n\u003cp>“We need to embrace this proven, effective approach to meth addiction, make it clearly legal and start reimbursing for it, so we can address this health epidemic,” says state Sen. Scott Wiener, D-San Francisco, who sponsored the bill.\u003c/p>\n\u003cp>[aside label=\"related coverage\" tag=\"drug-addiction\"]\u003c/p>\n\u003cp>Wiener says he was surprised to see the bill pass the California Legislature with near unanimous, bipartisan support.\u003c/p>\n\u003cp>“The Republicans love it,” he says. “I didn’t think they would, but they actually like it because there’s an abstinence component to it: We pay you money and you abstain from using.”\u003c/p>\n\u003cp>The state’s Department of Health Care Services, which runs California’s Medicaid program, known as Medi-Cal, also is on board. Department leaders have already asked federal regulators for explicit permission to offer contingency management through a statewide pilot project, and the feds appear poised to grant it.\u003c/p>\n\u003cp>Until quite recently, the federal government has been reluctant to relax rules that bar public health programs from offering contingency management. In 2020, during the Trump administration, treatment experts asked the U.S. Department of Health and Human Services to waive the rules for two years, but \u003ca href=\"https://www.nytimes.com/2020/10/27/health/meth-addiction-treatment.html\">the agency refused\u003c/a>.\u003c/p>\n\u003cp>“It’s clear the [Trump] administration had minimal interest in looking at evidence or science, on a wide variety of topics,” says Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation, which helped sponsor the bill.\u003c/p>\n\u003cp>The Biden administration, on the other hand, specifically stated in its \u003ca href=\"https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf\">2021 drug control policy\u003c/a> that one of its main priorities is to “identify and address policy barriers related to contingency management.”\u003c/p>\n\u003ch3>As stimulant overdoses soar, California looks to a proven behavioral intervention\u003c/h3>\n\u003cp>The need is urgent, explains \u003ca href=\"https://www.chcf.org/person/kelly-pfeifer/\">Dr. Kelly Pfeifer\u003c/a>, deputy director of behavioral health at the California Department of Health Care Services. In 2020, \u003ca href=\"https://www.dhcs.ca.gov/services/Documents/CA-Overdose-Increases-2020.pdf\">more Californians died from meth and cocaine overdoses than from fentanyl overdoses\u003c/a>, and stimulant abuse is wreaking havoc on California’s jails and courts, foster care and hospitals.\u003c/p>\n\u003cp>“Which are obviously not only devastating to the person and the family, but very expensive for our health care system,” Pfiefer says.\u003c/p>\n\u003cp>There’s also an increasing sense of hopelessness among people who use stimulants, she adds, because of the lack of effective, available treatments. For opioid addiction, there are now three FDA-approved medication therapies: methadone, buprenorphine and naltrexone. For meth and coke, there are no such medications.\u003c/p>\n\u003cp>Making contingency management more widely available would make more people willing to seek treatment, Pfiefer says.\u003c/p>\n\u003cp>“Because people will see success stories,” she says. “They’ll see friends and family getting treatment and getting help and getting better.”\u003c/p>\n\u003cp>One drawback of contingency management is that the \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/24750232/\">benefits may dwindle once the active treatment ends\u003c/a>. For that reason, some doctors believe the incentive treatment should be delivered continuously, in the same way that medication therapies for opioid use disorder are sometimes prescribed indefinitely. But new research indicates the benefits may last longer than previously thought. In a review of 23 previously published trials, researchers at the University of Connecticut found that people who participated in contingency management were \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/33507776/\">22% more likely to be abstinent six months after treatment ended\u003c/a> than people who received other treatments.\u003c/p>\n\u003cp>For Billy Lemon, contingency management was just what he needed to jumpstart his recovery, and to stay the course in residential rehab. When he cashed out all his incentive payments, he used the $330 to buy himself a new cellphone.\u003c/p>\n\u003cp>“Because up until then, ‘Breaking Bad’-style is burner phones,” he says, referring to the prepaid disposable phones that people who sell drugs use, then discard, to avoid detection by the police. “My number was never the same.”\u003c/p>\n\u003cp>Now, nine years later, \u003ca href=\"https://www.kqed.org/news/11855841/kamala-harris-is-my-fairy-godmother-a-vp-super-fan-says-she-saved-his-life\">he’s still sober\u003c/a> — he runs the Castro Country Club, a recovery space in San Francisco — and the number he got with his new phone is still his number.\u003c/p>\n\u003cp>“It’s a nice reminder of what making good decisions for yourself can turn into,” he says.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This story comes from NPR’s health reporting partnership with KQED and Kaiser Health News.\u003c/em>\u003c/p>\n\n",
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"excerpt": "A bill now on the governor's desk would allow the state's Medicaid program to pay for contingency management services, with the goal of encouraging more drug treatment centers to offer it.",
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"title": "California May Be First State to Try Treatment That Pays People Not to Use Meth | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cem>This is an updated version of a post that originally published on Jan. 8, 2021.\u003c/em>\u003c/p>\n\u003cp>When Billy Lemon was trying to kick his methamphetamine addiction, he went to a drug treatment program at the \u003ca href=\"https://www.sfaf.org/programs/stonewall-project/positive-reinforcement-opportunity-project-prop/\">San Francisco AIDS Foundation\u003c/a> three times a week and peed in a cup. If it tested negative for meth, he got paid about $7.\u003c/p>\n\u003cp>“For somebody who had not had any legitimate money — without committing felonies — that seemed like a cool thing,” says Lemon, who was arrested three times for selling meth before starting recovery.\u003c/p>\n\u003cp>The payments were part of an addiction treatment called contingency management, which incentivizes people who use drugs with money or gift cards to stay off drugs. At the end of 12 weeks, after all his drug tests came back negative for meth, Lemon received $330. But for him, it was about more than just the money. It was being told: Good job.\u003c/p>\n\u003cp>“It was the first opportunity where I was like, I have self-worth still. It’s buried. This person sees it and is willing to give me $7, just to take care of myself. That was very motivating,” he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>As overdoses and public health costs related to meth and cocaine use continue to spiral in California, state officials are desperate for more effective treatment options and are pursuing legislation and appealing to federal regulators to make contingency management more widely available. Washington, Montana and West Virginia also are exploring similar strategies.\u003c/p>\n\u003cp>Studies show that contingency management works. The principles of the treatment — positive reinforcement, primarily — are used widely in weight loss, fitness programs and in families, as parents coax their children into adopting positive behaviors, rather than punishing them for negative ones.\u003c/p>\n\u003cp>Research shows \u003ca href=\"https://storage.googleapis.com/plos-corpus-prod/10.1371/journal.pmed.1002715/1/pmed.1002715.pdf?X-Goog-Algorithm=GOOG4-RSA-SHA256&X-Goog-Credential=wombat-sa%40plos-prod.iam.gserviceaccount.com%2F20210929%2Fauto%2Fstorage%2Fgoog4_request&X-Goog-Date=20210929T232600Z&X-Goog-Expires=86400&X-Goog-SignedHeaders=host&X-Goog-Signature=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\">contingency management is the most effective treatment for meth or cocaine addiction\u003c/a>, especially when combined with other behavioral therapy. At the San Francisco AIDS Foundation, 63% of people who participated in the program in 2019 stopped using meth entirely, and another 19% reduced their use.\u003c/p>\n\u003cfigure id=\"attachment_11890594\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-11890594 size-medium\" src=\"https://ww2.kqed.org/app/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg\" alt=\"A man in sunglasses and a hat stands beneath a Pride flag outside a Victorian with a sign that says Castro Country Club.\" width=\"800\" height=\"600\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-800x600.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-1020x765.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200-160x120.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/10/2021/01/rs46611_009_sanfrancisco_billylemon_01142021-qut-1536x1024-2-93d1d0b27c5ab9ae1460333fecf87ea21095e212-s1200.jpg 1200w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Billy Lemon, 50, kicked his meth habit more than nine years ago after taking part in a ‘contingency management’ program for people who use meth and cocaine at the San Francisco AIDS Foundation. For every negative drug test, he earned a small amount of money. Lemon now runs the Castro Country Club, a recovery center in San Francisco. \u003ccite>(Beth LaBerge/KQED)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>The Department of Veterans Affairs has relied on the therapy to treat 5,600 vets over the last 10 years. Of the 73,000 urine samples collected in the VA program, 92% tested negative for drugs, according to \u003ca href=\"https://blogs.va.gov/VAntage/64870/how-va-uses-contingency-management-help-veterans-stay-drug-free/\">Dominick DePhilippis\u003c/a>, a clinical psychologist at the Philadelphia Center of Excellence for Substance Abuse Treatment and Education who helped launch the VA’s program.\u003c/p>\n\u003cp>“Patients often come to treatment ambivalent about change. Why? Because substance use is so seductive. It provides powerful, immediate reinforcement,” DePhilippis says. “Whereas recovery, its immediate consequences, are often unpleasant: withdrawal symptoms, a clear-eyed view of the devastated landscape that is one’s life.”\u003c/p>\n\u003cp>Contingency management embraces this challenge head on, he adds, by offering immediate rewards and reinforcement for abstinence. The small payments or prizes aim to rewire the brain’s reward system, so the person seeks the money or gift card to get a dopamine release, instead of meth or coke.\u003c/p>\n\u003cp>“You’re like, ‘Oh! Oh! I can feel good without the daily use of that substance. Let me try and go one more week,'” says Lemon. “And then all of a sudden, you’re at 90 days and you’ve actually made a change.”\u003c/p>\n\u003cp>Despite its effectiveness, the treatment is controversial. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3049167/\">Critics have scoffed at the idea of paying people who use drugs not to use drugs\u003c/a>, calling it unethical or a bribe. Most insurers don’t cover it. Neither do state Medicaid programs. The \u003ca href=\"https://www.healthaffairs.org/do/10.1377/hblog20200305.965186/full/\">feds generally forbid them from offering financial incentives to patients\u003c/a>, as a protection against fraud and waste, and state officials have interpreted that rule as prohibiting reimbursement for contingency management.\u003c/p>\n\u003ch3>California will try to scale up an effective treatment for stimulant addiction\u003c/h3>\n\u003cp>But as the drug epidemic continues to worsen throughout California and the nation, with \u003ca href=\"https://www.drugabuse.gov/news-events/news-releases/2021/09/methamphetamine-involved-overdose-deaths-nearly-tripled-between-2015-to-2019-nih-study-finds\">overdoses from stimulants like meth tripling in recent years\u003c/a>, state officials are questioning those policies and pushing for changes. Critics are softening their stance. A bill now on the governor’s desk — \u003ca href=\"https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=202120220SB110\">Senate Bill 110\u003c/a> — would allow the state’s Medicaid program to pay for contingency management services, with the goal of encouraging more drug treatment centers to offer it.\u003c/p>\n\u003cp>“We need to embrace this proven, effective approach to meth addiction, make it clearly legal and start reimbursing for it, so we can address this health epidemic,” says state Sen. Scott Wiener, D-San Francisco, who sponsored the bill.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Wiener says he was surprised to see the bill pass the California Legislature with near unanimous, bipartisan support.\u003c/p>\n\u003cp>“The Republicans love it,” he says. “I didn’t think they would, but they actually like it because there’s an abstinence component to it: We pay you money and you abstain from using.”\u003c/p>\n\u003cp>The state’s Department of Health Care Services, which runs California’s Medicaid program, known as Medi-Cal, also is on board. Department leaders have already asked federal regulators for explicit permission to offer contingency management through a statewide pilot project, and the feds appear poised to grant it.\u003c/p>\n\u003cp>Until quite recently, the federal government has been reluctant to relax rules that bar public health programs from offering contingency management. In 2020, during the Trump administration, treatment experts asked the U.S. Department of Health and Human Services to waive the rules for two years, but \u003ca href=\"https://www.nytimes.com/2020/10/27/health/meth-addiction-treatment.html\">the agency refused\u003c/a>.\u003c/p>\n\u003cp>“It’s clear the [Trump] administration had minimal interest in looking at evidence or science, on a wide variety of topics,” says Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation, which helped sponsor the bill.\u003c/p>\n\u003cp>The Biden administration, on the other hand, specifically stated in its \u003ca href=\"https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf\">2021 drug control policy\u003c/a> that one of its main priorities is to “identify and address policy barriers related to contingency management.”\u003c/p>\n\u003ch3>As stimulant overdoses soar, California looks to a proven behavioral intervention\u003c/h3>\n\u003cp>The need is urgent, explains \u003ca href=\"https://www.chcf.org/person/kelly-pfeifer/\">Dr. Kelly Pfeifer\u003c/a>, deputy director of behavioral health at the California Department of Health Care Services. In 2020, \u003ca href=\"https://www.dhcs.ca.gov/services/Documents/CA-Overdose-Increases-2020.pdf\">more Californians died from meth and cocaine overdoses than from fentanyl overdoses\u003c/a>, and stimulant abuse is wreaking havoc on California’s jails and courts, foster care and hospitals.\u003c/p>\n\u003cp>“Which are obviously not only devastating to the person and the family, but very expensive for our health care system,” Pfiefer says.\u003c/p>\n\u003cp>There’s also an increasing sense of hopelessness among people who use stimulants, she adds, because of the lack of effective, available treatments. For opioid addiction, there are now three FDA-approved medication therapies: methadone, buprenorphine and naltrexone. For meth and coke, there are no such medications.\u003c/p>\n\u003cp>Making contingency management more widely available would make more people willing to seek treatment, Pfiefer says.\u003c/p>\n\u003cp>“Because people will see success stories,” she says. “They’ll see friends and family getting treatment and getting help and getting better.”\u003c/p>\n\u003cp>One drawback of contingency management is that the \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/24750232/\">benefits may dwindle once the active treatment ends\u003c/a>. For that reason, some doctors believe the incentive treatment should be delivered continuously, in the same way that medication therapies for opioid use disorder are sometimes prescribed indefinitely. But new research indicates the benefits may last longer than previously thought. In a review of 23 previously published trials, researchers at the University of Connecticut found that people who participated in contingency management were \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/33507776/\">22% more likely to be abstinent six months after treatment ended\u003c/a> than people who received other treatments.\u003c/p>\n\u003cp>For Billy Lemon, contingency management was just what he needed to jumpstart his recovery, and to stay the course in residential rehab. When he cashed out all his incentive payments, he used the $330 to buy himself a new cellphone.\u003c/p>\n\u003cp>“Because up until then, ‘Breaking Bad’-style is burner phones,” he says, referring to the prepaid disposable phones that people who sell drugs use, then discard, to avoid detection by the police. “My number was never the same.”\u003c/p>\n\u003cp>Now, nine years later, \u003ca href=\"https://www.kqed.org/news/11855841/kamala-harris-is-my-fairy-godmother-a-vp-super-fan-says-she-saved-his-life\">he’s still sober\u003c/a> — he runs the Castro Country Club, a recovery space in San Francisco — and the number he got with his new phone is still his number.\u003c/p>\n\u003cp>“It’s a nice reminder of what making good decisions for yourself can turn into,” he says.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>This story comes from NPR’s health reporting partnership with KQED and Kaiser Health News.\u003c/em>\u003c/p>\n\n\u003c/div>\u003c/p>",
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"info": "Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.",
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"soldout": {
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"title": "SOLD OUT: Rethinking Housing in America",
"tagline": "A new future for housing",
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