‘What’s the freaking gap’: SF health officials in hot seat as supervisors demand answers on drug treatment

The Department of Public Health (DPH) is touting a less than one-day wait time for people entering the city’s addiction treatment programs—a claim that city leaders are struggling to make sense of amid crushing overdose rates, stubborn open-air drug markets and anecdotal reports of difficulty in accessing treatment. 

At a hearing on Thursday, supervisors questioned the health department’s data and demanded answers on what they viewed as inconsistencies, citing an annual “treatment on demand” report that showed a decline in treatment admissions as well as fewer people with addiction in the city than a few years ago.  

“You don't want to tell us things are bad; maybe things aren't bad, but it's helpful for us to know what's the freaking gap,” said Supervisor Rafael Mandelman, who called the hearing partly over frustrations with the department’s handling of behavioral health issues. 

The health department pinned the decrease in treatment admissions to state policy that restricts the city from admitting out-of-town patients. Department officials pointed to expanded access to buprenorphine and naloxone among other efforts to stem the city’s drug overdose crisis, and asserted that San Francisco is doing better than surrounding counties in providing addiction care. 

Supervisors didn’t find that particularly convincing, however, pointing out that what they’ve heard from providers doesn’t track with the department’s report. 

As an overdose crisis rages on, some providers have reported difficulty in admitting patients to methadone clinics—a low-barrier form of treatment for opioid use disorder. Meanwhile, health-care workers have increasingly raised the alarm about dangerous conditions at facilities that receive patients with mental illness and addiction, citing a revolving door at emergency units and high staff turnover. 

Supervisor Catherine Stefani cited a state audit that found San Francisco isn’t meeting expectations in providing timely care with an experienced health-care workforce.

“I don’t want to gloss over the frictions,” said DPH Behavioral Health Director Hillary Kunins. “I concur profoundly that we need to measure what we're doing; we need to know impact, and we've tried to do that better and better.”

The health department’s report acknowledged gaps in treatment for people with coexisting mental health diagnoses, language barriers and those involved in the criminal justice system. A presentation from the adult probation department showed the average wait time to enter treatment from jail is six days—though that figure is an improvement from the reported average 49-day wait time last year.  

More than 1,700 people have fatally overdosed in the city since January 2020, with the addiction epidemic ranking among residents’ top concerns. The city has allocated $75 million dollars this year to provide substance use treatment, contracting with nonprofits to carry out much of that work.  

Supervisors have ramped up calls for oversight of city-contracted nonprofits, with those calls growing louder following news that a top public health director worked a second job at a financially troubled drug rehab contractor. 

That contractor, called Baker Places, inexplicably came up short $4.2 million this fall just months after the Board of Supervisors approved a bailout for the organization, which had fallen into debt despite millions in city-sponsored contracts. 

Supervisors cried foul after Baker Places and its administrative arm, Positive Resource Center, reported the unexpected shortfall—and this week indicated plans to take a closer look at the performance of city-contracted nonprofits.