A "meth sobering center" was just one recommendation in a 45-page report released by San Francisco's Methamphetamine Task Force on Oct. 22. The city's Department of Public Health (SFDPH) announced the creation of this task force in February to sketch a broad vision for how city leaders and health officials should address the epidemic of meth use in the city. This comes after a decade-long rise in overdose deaths and emergency room visits linked to meth. A sobering statistic from the report: Nearly half of the people visiting psychiatric emergency services at one city hospital are high on meth.
San Francisco is not alone. Although meth use decreased earlier in the decade after lawmakers restricted access to key ingredients used to make crystal meth like over-the-counter pseudoephedrine, meth use nationally is at an all-time high and touches every race and socioeconomic class, according to the U.S. Drug Enforcement Agency. The DEA says drug cartels in Mexico have been flooding the U.S. with cheap, potent methamphetamine from "superlabs." The risks of meth use include "violent encounters, property damage, thefts, and hazardous waste," according to the report, in addition to physical problems such as a risk of heart attacks, stroke, and tooth decay. While far less frequent than opioid overdoses, meth overdose deaths in San Francisco have tripled since 2008. Mortality rates are highest for African Americans there and skyrocketed in this group from 2014 to 2015, the report found.
The task force is focused on harm reduction, according to Grant Colfax, M.D., director of health at SFDPH and co-chair, along with Supervisor Rafael Mandelman, of the Methamphetamine Task Force. "We listened to key stakeholders and people with lived experience with meth and looked at how to provide services that meet people's needs where they are, whether they're on the streets or not. It's a harm-reduction continuum that is meeting people in a low- or no-barrier way," Colfax says.
The report outlines how various city agencies and law enforcement can more effectively work together, and most of the recommendations focus on making it easier for meth users to get help. Colfax and Mandelman call on city agencies to overhaul how they handle crisis interventions. Right now, people suffering meth-induced psychosis will call 911, which results in law enforcement intervening. That response wastes resources and brings the user no closer to treatment, but does put them at risk of arrest.
One of the report's 17 recommendations, a meth sobering center, will be opened within six months, Colfax says, and will be similar to an alcohol sobering center the city has operated since 2003. According to SFDPH, the center will help people ride out their high and offer them options for treatment, lessening the caseload of the city's overwhelmed psychiatric emergency services. Other recommendations in the report include overdose prevention programs, which might include supervised injection sites similar to sites aimed at preventing opioid overdose that are being set up in Seattle and Philadelphia.
The report also recommended improving residential programs, and a street response team, rather than police, to de-escalate public situations involving meth users. The behavioral crisis street response team could be called by dialing 311. The recommendations would require more staff, services, and housing, though the report does not put a dollar figure on all the possible initiatives.
The HIV Connection
There is plenty of research linking meth use to a propensity for sexual risk-taking and HIV transmission, and one study concluded meth could negatively impact the health of HIV-positive users. Aggressive efforts to end the HIV epidemic have helped San Francisco steadily reduce the rate of HIV transmission over the past five years, with a very big caveat: At-risk and underserved populations -- including people who are homeless, African American, Latinx, or injection drug users -- continue to suffer disproportionately from HIV infections and deaths, according to a recent report from the SFDPH.
Advocates say the escalating meth crisis threatens to undermine the gains made in the HIV fight, especially for vulnerable groups. So the Methamphetamine Task Force comes not a day too soon, according to Laura Thomas, director of harm reduction policy at the San Francisco AIDS Foundation. "When you look at gay and bi men who inject drugs, we haven't done as good of a job protecting them. Meth use is causing them to be at a higher risk of HIV, especially if they inject it and share needles."
Thomas, who was involved in the creation of the Methamphetamine Task Force, points out that meth use has been an issue in the city for decades, but the profile of users has changed. More than a decade ago, San Francisco had a task force looking at meth use among gay and bisexual men, but it was disbanded in the wake of the 2008 financial crisis -- and none of its recommendations were implemented. A decade later, meth use has expanded to include people of color, sex workers, and, increasingly, homeless people.
That new face of meth use is concerning to Charles Hawthorne, capacity-building coordinator with the Harm Reduction Coalition. "There's a rising rate of homelessness in the city, and some unhoused people will use meth to stay safe on the streets, or to work more," Hawthorne says. "And when people use drugs, they're not as vigilant about protection. And they may also have trouble accessing HIV care and treatment."
If the Methamphetamine Task Force succeeds in getting people re-engaged in health care or treatment, or allows people to use safely, it could be a success, Hawthorne says. But he adds that he would like his organization to be part of the task force, "so we can be sure it has an emphasis on harm reduction."