By St. John Barned-Smith, Maggie Angst
May 10, 2024
The exterior of a former Tenderloin hotel where the city now runs a managed alcohol program on Eddy Street in San Francisco on Thursday, May 9, 2024.
Gabrielle Lurie/The Chronicle
For a small slice of San Francisco’s homeless population that struggles with severe alcohol addiction, nurses offer treatment not in a pill, but in a shot of vodka or a glass of beer.
It may sound counterintuitive, experts say, but it helps keep people off the streets and out of emergency rooms, jails — or the morgue.
San Francisco set up a “managed alcohol program” four years ago as a way to care for vulnerable homeless people who drank excessive amounts of alcohol and were among the city’s highest users of emergency services.
Since its creation, the program, which started out with 10 beds, has served 55 clients, according to officials from the Department of Public Health. The now 20-bed program, which costs about $5 million per year, operates out of a former hotel in the heart of the Tenderloin. Nurses dispense regimented doses of vodka and beer to participants at certain times of day based on care plans.
Such programs don’t focus on sobriety, experts say, but rather on improving participants’ overall health while decreasing hospital stays and calls to police.
The exterior of a former Tenderloin hotel where the city runs a managed alcohol program on Eddy Street in San Francisco. Nurses at the facility dispense regimented doses of vodka and beer to participants at certain times of day based on care plans.
Gabrielle Lurie/The Chronicle
But the city’s efforts came under scrutiny this week, after the chair of the board of a local nonprofit that pushes abstinence shared posts on social media accusing the city of wasting millions of taxpayer dollars on a program that gives booze to homeless people struggling with alcohol addiction.
Adam Nathan of Salvation Army San Francisco said on X that “providing free drugs to drug addicts doesn't solve their problems. It just stretches them out. Where's the recovery in all of this?”
The social media skirmish was the latest flare-up in an increasingly tense debate about San Francisco’s use of harm reduction, which focuses on cutting negative health effects of alcohol and drug use rather than requiring people to stop using. As homelessness and overdose deaths have continued to plague the city, critics have excoriated San Francisco’s attempts at harm reduction, saying they only enable addiction and despair.
Abstinence-groups such as the Salvation Army have ridiculed the city for spending public funds on initiatives that provide drug users with overdose-reversing drugs, clean needles and foil for methamphetamine and fentanyl consumption.
Even Mayor London Breed in February said that harm reduction was “not reducing the harm” but “making things far worse.” That stance puts her at odds with her own public health department, which staunchly stands by harm reduction as an integral part of the agency’s system of care. Breed recently tried to open abstinence-only housing for formerly homeless people near Chinatown but scrapped the proposal amid neighborhood backlash.
“Are we just going to manage people’s addictions with our taxpayer dollars in perpetuity forever? It seems like that’s basically what we’re saying,” said Tom Wolf, who is in recovery for heroin addiction. “... I think we should be spending that money on detox and recovery.”
But Shannon Smith-Bernardin, a professor at the UCSF School of Nursing who helped create the managed alcohol programs in San Francisco and Alameda County, explained that the goal is to stabilize participants’ alcohol use “so they're not binge drinking or stopping drinking and having seizures and then … start figuring out what's next.”
The exterior of a former Tenderloin hotel where the city now runs a managed alcohol program on Eddy Street in San Francisco on Thursday, May 9, 2024.
Gabrielle Lurie/The Chronicle
The program also offers participants medications and therapy to reduce alcohol cravings.
The controversy erupted Tuesday night after Nathan claimed on X that he stumbled upon an “old hotel in SOMA” where kegs were set up to give out “free beer to the homeless.” Nathan continued that it was “set up so people in the program just walk in and grab a beer, and then another one.”
Officials from Salvation Army San Francisco referred questions to Nathan, who told the Chronicle Thursday that he felt the lack of public knowledge about the program reflected the fact that San Francisco’s public health department is worried about how “the program will be perceived by the public and that to me was validated by the reaction to what I tweeted.” His initial post garnered more than 3,000 likes and more than 13,000 people took part in a poll asking whether they supported such a program. More than 80% of X users who responded to the poll indicated they were opposed.
Public health officials countered that the claims made in Nathan’s posts misrepresented the program and misled the public.
Alcohol is dispensed by a nurse and unhoused people who aren’t in the program may not walk into the facility to get free alcohol, according to a statement from the public health department. The program is run out of a former Tenderloin tourist hotel that has a bar, but the on-site taps are “inoperable and unused,” the statement continued.
Nathan also criticized the use of millions of city dollars to fund the program.
The Salvation Army has itself been accused of wasting taxpayer money. BART paid the nonprofit $350,000 for a program to tackle surging homelessness on trains, but only one person received services, according to a scathing report from the transit agency's inspector general.
But San Francisco public health officials found that the city saved $1.7 million over six months from the managed alcohol program in reduced calls to emergency services, including emergency room visits and other hospital stays. In the six months after clients entered the managed alcohol program, public health officials said visits to the city’s sobering center dropped 92%, emergency room visits dropped more than 70%, and EMS calls and hospital visits were both cut in half.
Previously, the city reported that just five residents who struggled with alcohol use disorder had cost more than $4 million in ambulance transports over a five year period, with as many as 2,000 ambulance transports over that time.
The San Francisco Fire Department said in a statement that the managed alcohol program has “has proven to be an incredibly impactful intervention” at reducing emergency service use for a “small but highly vulnerable population.”
The city's public health department is working to get some of the program costs reimbursed through MediCal, according to a spokesperson.
San Francisco public health officials launched the managed alcohol program during the early days of the pandemic, as the city worked quickly to get homeless residents — more than half of whom struggle with a drug or alcohol addiction — into hotel and motel rooms.
Public health officials were concerned that the isolation and quarantine mandates would prevent access to alcohol — leading to potential withdrawal. Detoxing from alcohol is particularly dangerous and can cause hallucinations and seizures that turn fatal.
“We were trying to figure out how to keep people who are homeless alive during COVID,” recalled Smith-Bernardin, “but also work with them around their medical needs.”.
In an October presentation, public health staff pointed to one story of a 38-year-old man suffering from addiction and psychotic disorder. He reportedly had more than 36 ER visits over nine months with high blood alcohol content. In the nine months after joining the program, that number fell to just six ER visits.
Program officials said that nurses assess patients and typically dispense the equivalent of 1-2 drinks 3-4 times per day — doling out either 1.7 ounces of vodka or liquor, 5 ounces of wine, or 12 ounces of beer.
In addition to offering medication and therapy, the program provides cultural outings and life skills classes, according to the public health department’s presentation.
The department of public health said that some participants have been discharged from the program for a higher level of care, other housing or a recovery program. Officials said several participants died after voluntarily leaving the program as a result of their end stage alcoholism.
While such programs are rare in the United States, they are more common in other countries, including Canada, Portugal and the U.K. And experts say such programs provide stability and support to homeless people who cycle from the streets to emergency rooms and jail.
In Canada, where managed alcohol programs have operated for more than a decade, more than 40 programs are currently in place, according to the University of Victoria’s Canadian Institute for Substance Use Research.
A 2022 study of Canada’s managed alcohol programs found that participation reduced the risk of death and resulted in fewer hospital stays for individuals with unstable housing and severe alcohol addiction.
“It’s a better way to spend our money than someone being in a jail or hospital where they are not getting care for their health needs,” said Dr. Bernie Pauly, a leading medical researcher who has pioneered much of Canada’s programs.
Source (Archive)
May 10, 2024
The exterior of a former Tenderloin hotel where the city now runs a managed alcohol program on Eddy Street in San Francisco on Thursday, May 9, 2024.
Gabrielle Lurie/The Chronicle
For a small slice of San Francisco’s homeless population that struggles with severe alcohol addiction, nurses offer treatment not in a pill, but in a shot of vodka or a glass of beer.
It may sound counterintuitive, experts say, but it helps keep people off the streets and out of emergency rooms, jails — or the morgue.
San Francisco set up a “managed alcohol program” four years ago as a way to care for vulnerable homeless people who drank excessive amounts of alcohol and were among the city’s highest users of emergency services.
Since its creation, the program, which started out with 10 beds, has served 55 clients, according to officials from the Department of Public Health. The now 20-bed program, which costs about $5 million per year, operates out of a former hotel in the heart of the Tenderloin. Nurses dispense regimented doses of vodka and beer to participants at certain times of day based on care plans.
Such programs don’t focus on sobriety, experts say, but rather on improving participants’ overall health while decreasing hospital stays and calls to police.
The exterior of a former Tenderloin hotel where the city runs a managed alcohol program on Eddy Street in San Francisco. Nurses at the facility dispense regimented doses of vodka and beer to participants at certain times of day based on care plans.
Gabrielle Lurie/The Chronicle
But the city’s efforts came under scrutiny this week, after the chair of the board of a local nonprofit that pushes abstinence shared posts on social media accusing the city of wasting millions of taxpayer dollars on a program that gives booze to homeless people struggling with alcohol addiction.
Adam Nathan of Salvation Army San Francisco said on X that “providing free drugs to drug addicts doesn't solve their problems. It just stretches them out. Where's the recovery in all of this?”
The social media skirmish was the latest flare-up in an increasingly tense debate about San Francisco’s use of harm reduction, which focuses on cutting negative health effects of alcohol and drug use rather than requiring people to stop using. As homelessness and overdose deaths have continued to plague the city, critics have excoriated San Francisco’s attempts at harm reduction, saying they only enable addiction and despair.
Abstinence-groups such as the Salvation Army have ridiculed the city for spending public funds on initiatives that provide drug users with overdose-reversing drugs, clean needles and foil for methamphetamine and fentanyl consumption.
Even Mayor London Breed in February said that harm reduction was “not reducing the harm” but “making things far worse.” That stance puts her at odds with her own public health department, which staunchly stands by harm reduction as an integral part of the agency’s system of care. Breed recently tried to open abstinence-only housing for formerly homeless people near Chinatown but scrapped the proposal amid neighborhood backlash.
“Are we just going to manage people’s addictions with our taxpayer dollars in perpetuity forever? It seems like that’s basically what we’re saying,” said Tom Wolf, who is in recovery for heroin addiction. “... I think we should be spending that money on detox and recovery.”
But Shannon Smith-Bernardin, a professor at the UCSF School of Nursing who helped create the managed alcohol programs in San Francisco and Alameda County, explained that the goal is to stabilize participants’ alcohol use “so they're not binge drinking or stopping drinking and having seizures and then … start figuring out what's next.”
The exterior of a former Tenderloin hotel where the city now runs a managed alcohol program on Eddy Street in San Francisco on Thursday, May 9, 2024.
Gabrielle Lurie/The Chronicle
The program also offers participants medications and therapy to reduce alcohol cravings.
The controversy erupted Tuesday night after Nathan claimed on X that he stumbled upon an “old hotel in SOMA” where kegs were set up to give out “free beer to the homeless.” Nathan continued that it was “set up so people in the program just walk in and grab a beer, and then another one.”
Officials from Salvation Army San Francisco referred questions to Nathan, who told the Chronicle Thursday that he felt the lack of public knowledge about the program reflected the fact that San Francisco’s public health department is worried about how “the program will be perceived by the public and that to me was validated by the reaction to what I tweeted.” His initial post garnered more than 3,000 likes and more than 13,000 people took part in a poll asking whether they supported such a program. More than 80% of X users who responded to the poll indicated they were opposed.
Public health officials countered that the claims made in Nathan’s posts misrepresented the program and misled the public.
Alcohol is dispensed by a nurse and unhoused people who aren’t in the program may not walk into the facility to get free alcohol, according to a statement from the public health department. The program is run out of a former Tenderloin tourist hotel that has a bar, but the on-site taps are “inoperable and unused,” the statement continued.
Nathan also criticized the use of millions of city dollars to fund the program.
The Salvation Army has itself been accused of wasting taxpayer money. BART paid the nonprofit $350,000 for a program to tackle surging homelessness on trains, but only one person received services, according to a scathing report from the transit agency's inspector general.
But San Francisco public health officials found that the city saved $1.7 million over six months from the managed alcohol program in reduced calls to emergency services, including emergency room visits and other hospital stays. In the six months after clients entered the managed alcohol program, public health officials said visits to the city’s sobering center dropped 92%, emergency room visits dropped more than 70%, and EMS calls and hospital visits were both cut in half.
Previously, the city reported that just five residents who struggled with alcohol use disorder had cost more than $4 million in ambulance transports over a five year period, with as many as 2,000 ambulance transports over that time.
The San Francisco Fire Department said in a statement that the managed alcohol program has “has proven to be an incredibly impactful intervention” at reducing emergency service use for a “small but highly vulnerable population.”
The city's public health department is working to get some of the program costs reimbursed through MediCal, according to a spokesperson.
San Francisco public health officials launched the managed alcohol program during the early days of the pandemic, as the city worked quickly to get homeless residents — more than half of whom struggle with a drug or alcohol addiction — into hotel and motel rooms.
Public health officials were concerned that the isolation and quarantine mandates would prevent access to alcohol — leading to potential withdrawal. Detoxing from alcohol is particularly dangerous and can cause hallucinations and seizures that turn fatal.
“We were trying to figure out how to keep people who are homeless alive during COVID,” recalled Smith-Bernardin, “but also work with them around their medical needs.”.
In an October presentation, public health staff pointed to one story of a 38-year-old man suffering from addiction and psychotic disorder. He reportedly had more than 36 ER visits over nine months with high blood alcohol content. In the nine months after joining the program, that number fell to just six ER visits.
Program officials said that nurses assess patients and typically dispense the equivalent of 1-2 drinks 3-4 times per day — doling out either 1.7 ounces of vodka or liquor, 5 ounces of wine, or 12 ounces of beer.
In addition to offering medication and therapy, the program provides cultural outings and life skills classes, according to the public health department’s presentation.
The department of public health said that some participants have been discharged from the program for a higher level of care, other housing or a recovery program. Officials said several participants died after voluntarily leaving the program as a result of their end stage alcoholism.
While such programs are rare in the United States, they are more common in other countries, including Canada, Portugal and the U.K. And experts say such programs provide stability and support to homeless people who cycle from the streets to emergency rooms and jail.
In Canada, where managed alcohol programs have operated for more than a decade, more than 40 programs are currently in place, according to the University of Victoria’s Canadian Institute for Substance Use Research.
A 2022 study of Canada’s managed alcohol programs found that participation reduced the risk of death and resulted in fewer hospital stays for individuals with unstable housing and severe alcohol addiction.
“It’s a better way to spend our money than someone being in a jail or hospital where they are not getting care for their health needs,” said Dr. Bernie Pauly, a leading medical researcher who has pioneered much of Canada’s programs.
Source (Archive)
