WAITING TO QUIT CAN DRUG ADDICTS IN SAN FRANCISCO GET HELP WHEN THEY WANT
IT? NOT WITH 1,000 USERS ON WAITING LISTS.

SHAWN CAME CLOSE to kicking heroin a while back; he'd tried to kill
himself and was thrown in a city psychiatric ward. "I told them, 'I'm
depressed 'cause I'm strung out,' " he said. "They put me in a
three-day detox, put me on Prozac, and then put me out on the street."

There were no rehab beds available in San Francisco for
him.

Shawn has been addicted to junk on and off for the past five years. In
that time he's lost dozens of friends and shooting partners to
overdoses. "In 1994 I watched 23 of my friends die. It made 1995 the
year to stay alive. I've died twice myself and been revived," he says,
eyes bugging, his tattooed hands caked with grime and a spot of blood.
"Now I'm just a crabby old bastard."

Each day Shawn -- who is in his early 30s -- will peddle enough weed
to buy three grams of dope. He'll fix up seven or eight times a day.
When times are flush he sleeps in a rat-infested hotel. Most nights he
slumbers on the sidewalk.

Like many junkies, Shawn has tried repeatedly to get into treatment
programs. Each time he was told to wait. And every time he waited, he
got strung out again.

It is this phenomenon that led the Coalition on Homelessness, and then
the health department, to call for "treatment on demand" -- which
enables addicts to get into detox or rehab within 48 hours.

In fall 1996, the Board of Supervisors endorsed the
treatment-on-demand concept and called on Mayor Willie Brown to make
it a reality. Brown signed off on the idea, developing a five-year
pilot project and a planning council.

The city spent $27.8 million on substance abuse in 1996-1997. The next
year the city increased funding to $37.3 million and created 658 new
slots in methadone programs, rehabs, detoxes, and counseling programs.
But that has put only a minor dent in the problem. According to the
health department 1,000 addicts are on waiting lists for treatment --
down from 1,200 in '96. The city leads the nation in emergency room
visits due to heroin, LSD, and amphetamine use. Abscesses from
injections are the number one cause of admission to S.F. General
Hospital. There are 17,000 intravenous drug users in San Francisco at
any given time -- more than 200 died from overdoses last year, making
the city number one in the state for per capita overdose deaths.

The first place most addicts call when they are ready to quit is
Target Cities, San Francisco's central intake point for all rehab and
detox programs. A hotline worker there says it takes three or four
days to get an appointment at a city-funded clinic -- where the addict
will likely be placed on another waiting list.

Shawn tried to get into S.F. General's methadone program. He was put
on a two-week-to one-month-long waiting list. To hold his spot, Shawn
had to show up in person at the hospital every morning. He couldn't.
With a $150 a day habit, Shawn spent too much time just trying to
chase down a fix to turn up at General.

For Shawn the ideal treatment would be an inpatient, medically
assisted detox, followed by time in an inpatient rehab center where he
could get his life back together. Hard-drug users often need
prescription drugs to lessen the excruciating pain of withdrawal;
Shawn says he goes into seizures without heroin.

Baker Places offers the only 10 free residential detox beds in the
city. So most addicts going through the physical process of kicking,
which lasts 3 to 21 days, must find their own shelter, live on the
streets, or, if they choose another residential shelter, do without
most medicine and other drugs. The addicts who are able to
successfully detox in these conditions often have to wait additional
days or weeks to get into rehab.

The system is so backlogged that some social workers we talked to, who
asked to remain anonymous, say they don't even try to get clients into
treatment in San Francisco anymore. Instead they buy addicts seeking
help bus tickets to other cities with more accessible services, or
with supportive family members.

The 36-member Treatment on Demand Planning Council has drawn up a list
of five new programs intended to fix the glitches in the treatment
network. Its first priority is to make methadone available to 100 more
people. The council also wants a youth detox program, treatment in
jail, a teen outreach program, and a new inpatient detox program.

Insiders say Brown has tentatively agreed to fund 100 new slots in
methadone clinics but is less enthusiastic about the other programs
and has decided against funding the inpatient detox program.

The mayor did not return Bay Guardian phone calls by press
time.

The recommendations the mayor makes will be the first steps in a
budget-drafting process that will require the input and approval of
the city's 11 supervisors. At a May 10 board hearing on public health,
Sup. Barbara Kaufman called the programs a waste of money. Sup. Gavin
Newsom, on the other hand, has been a vocal proponent of increased
spending for drug treatment.

"The [treatment on demand] council is really appreciative that the
city has been generous and forthcoming in funding new treatment
programs the past two years," council member Michael Siever said. "We
hope they will continue that this year and provide enough money to
fund our top five priorities." A lack of new funding, Siever said,
"means people will continue to die of overdose and related causes.
There will continue to be costs to taxpayers in emergency room costs,
jail costs," and the like.