TREATMENT OF HEROIN USERS' SORES COST S.F. UP TO $40 MILLION YEARLY

SAN FRANCISCO -- San Francisco spends as much as $40 million a year
treating abscesses in heroin users, including infections caused by the
terrible flesh-eating bacteria, a supervisors committee was told yesterday.

``It is horrific, if you've ever, ever been unfortunate enough to
witness the people suffering from this,'' Supervisor Gavin Newsom said
of the abscess infections, which bring about 12 patients a day to the
San Francisco General Hospital emergency room. About half of them are
admitted for surgery, which often results in extensive scarring or
amputations.

The abscesses are associated with injecting heroin into muscles
instead of veins. The same black tar heroin that is responsible for
the rising number of abscesses is also behind the city's large number
of heroin overdoses. The heroin is growing more popular because its
price is dropping and it is purer and more powerful than the heroin
that used to be sold on the streets.

``San Francisco is experiencing a disproportionate burden,'' Newsom
said at the hearing of the Public Health and Environment Committee.
``There are more abscesses than we've ever seen and (the cases are)
clogging the emergency room.''

In fact, Dr. Joshua Bamberger, a researcher with the city Department
of Public Health, said the abscesses are the leading cause of patient
admissions to the hospital. Anyone who wants to know why the
department faces a $15 million budget deficit this year should look no
further than the heroin-related abscesses, he said.

The hospital handled 4,300 abscess cases in 1998-99, up from fewer
than 3,000 in 1995-96. He said the total cost to the city is as much
as $40million a year, including $18 million for inpatient care and
millions more for emergency room care, follow-up and paramedics' time.

Most of the addicts coming in for abscesses are uninsured and
ineligible for Medicaid, meaning that the city picks up the cost of
treating them.

The health department is seeking $1 million in Mayor Willie Brown's
new budget to set up a wound care center at the hospital, where heroin
users could go without tying up the emergency room and surgeons. The
money would also pay for a mobile clinic that could go out on the
street, along with needle exchange workers, to treat abscesses before
they get serious.

Bamberger said the city must persuade addicts to keep themselves
clean, which gives the bacteria less chance to grow on their skin, and
expand methadone treatment so people don't go back to using heroin
after the current standard of three weeks of treatment.

The scarring from the abscesses can ruin lives, recovering addict
Tracey Helton told the supervisors. ``In the last years of my
addiction I thought I'd never be hired or a job because my scarring is
so extensive on my legs that I couldn't cover them, even with panty
hose,'' she said.

``The self-esteem issues on scarring are tremendous because people
feel they will never be accepted back into society,'' said Helton, who
now helps other addicts through the SAGE (Standing Against Global
Exploitation) Project.

Bamberger told the supervisors that 143 people died of heroin
overdoses in San Francisco in 1998, but that users on methadone are 20
times less likely to die from overdose.

That led Newsom to press his case for the city to get a federal waiver
that would allow private doctors to dispense methadone to patients and
to extend the detoxification treatment from 21 days to include several
more weeks. Methadone is now dispensed only at city-run programs.

Newsom expects such a federal and state waiver in little more than a
year.

Bamberger said the city has to do more outreach to heroin users to
prevent overdoses. One step would be to tell addicts not to mix
alcohol with heroin, since that combination spurs overdose symptoms.

He and other speakers also said users and their friends have to be
convinced that the police won't come along when paramedics are
summoned. Dr. Andrew Moss, a professor at the University of California
at San Francisco, reported findings of a study of 213 young heroin
users in the city that showed that paramedics were called in only 52
percent of overdoses.

Twenty-two percent who didn't call 911 were afraid of being arrested,
but only 5 percent of the users reported being arrested following an
overdose.

San Francisco police don't accompany paramedics on medical calls. ``We
need the police to tell users it's not department policy to go
along,'' Bamberger said.

Another more controversial and probably illegal suggestion was for
setting up a ``safe injection room patterned after a program in
Frankfurt, Germany. Addicts can come to a supervised location where
they are given clean needles and their injections are observed by
professionals.

Another suggestion was for the city to try a pilot program of
distributing Naloxone to addicts. This drug can quickly counteract the
symptoms of an overdose.