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San Francisco Pioneers Plan to Treat All Drug Users

Program will test whether treatment can reduce drug abuse - and save city money

By Loren SteinSpecial to The Christian Science Monitor / January 29, 1997


For six long years, crack cocaine owned Sandra Stewart. Growing up in a home where drugs were commonplace, she began smoking crack when she was a young single mother. Overcome by her addiction, she soon quit her paralegal job and found herself on the streets, living in shelters and cheap hotels.

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"I was using [crack] to numb the pain," she says. "I felt all alone. I was pregnant with twins and didn't know where to go. I was lost."

Later, when the state's Child Protective Services threatened to permanently take away her three small children, Ms. Stewart decided to seek help from San Francisco's drug-treatment programs. But what she found was an endless stretch of waiting lists, procedural problems, and poor services.

Despite the roadblocks, Stewart is now clean and sober. Yet she may be the exception: Many drug abusers still can't get treatment because the system is overcrowded.

In an unusual experiment, San Francisco is hoping to change all that. The city is creating the country's first "treatment on demand" program. Under the $20-million plan currently being drafted, the city will treat any drug user within 48 hours of asking for help.

Critics say the program is financially risky and smacks of big government. But supporters, including treatment providers and city health experts, argue that the societal and economic toll of drug abuse is too high to be ignored.

Thus the experiment may provide the nation's clearest test of whether expanded treatment can help eradicate the drug problem - and, in the long run, save money.

"I've never seen the leadership of any city embrace the notion of treatment on demand while recognizing the price tag of the plan," says David Mactas, director of the United States Department of Health and Human Services' Center for Substance Abuse Treatment.

"On social and public-health issues, San Francisco is right on target. It's an environment that encourages such vision...." Federal and city officials will be watching closely, he says. "We're all invested in the success of this program."

City's drug problem

Few would argue that San Francisco has a serious drug problem. It has the highest rate of heroin and methamphetamine-related emergency-room visits of any major city in the country. For cocaine, it ranks second. On any given day, the city turns away more than 1,300 drug users because programs are full.

Getting help

Stewart found her patience taxed. "When you're an addict, you have moments of clarity when you really want to get it together, to get ... into treatment," she says. "But you never get in - you wait. You're usually in an environment that's still using, and then you get sucked back into it. They call you four to five months later, but the moment in time has passed."

She has since been reunited with her children and works for Family Rights and Dignity, a local political advocacy group.

Supporters of the new program say untreated substance abuse costs San Francisco an estimated $1.7 billion a year, including indirect expenses absorbed by the criminal justice system, social services, hospitals, and businesses.

The direct cost to the city is $370 million a year, officials estimate. But this cost could be drastically cut, they contend. According to a 1994 California study, every $1 spent on treatment saves $7 one year later.