San Francisco Sends Doctors to Treat Addicts on the Street

San Francisco has become the first US city to launch a groundbreaking new program that will provide lifesaving opioid addiction treatment to homeless addicts directly on the streets.

In May 2018, the city’s mayor Mark Farrell pledged an investment of $6 million for the “first-in-the-nation initiative to address the national drug and opioid crisis” on San Francisco’s streets.”

As part of the program, a team of clinicians from the Department of Public Health’s Street Medicine Team go out onto the Bay Area streets and write buprenorphine prescriptions for drug-addicted homeless people.

Buprenorphine is a medicine that is taken daily to reduce withdrawal symptoms in drug users and has been shown to greatly help in fighting off addiction and reducing rates of overdose.

Dr. Barry Zevin, the city’s medical director for Street Medicine and Shelter Health, hopes to provide buprenorphine to 250 more people through the program. That’s only a tiny fraction of the estimated 22,500 people in San Francisco who actively inject drugs, he said, but it’s certainly a start.

“Most health care for the homeless happens under the model of waiting for people to come in to a health center,” Zevin told the New York Times. “But a lot of people never come in.”

“There are a lot of mental health, substance abuse and cognitive problems in this population, a lot of chronic illness,” he added. “Appointments are the enemy of homeless people. On the street there are no appointments, and no penalties or judgments for missing appointments.”

A year-long pilot study of the program showed that “virtually all of the people” who were approached by the clinicians were interested in the treatment. By the end of the study, about 20 of the 95 participants were still taking buprenorphine to treat their addiction with the help of the clinician team.

“The Street Medicine buprenorphine program is another important step to address the … crisis afflicting drug users in our community,” said Barbara Garcia, San Francisco Health Director. “Homeless people who use drugs are especially vulnerable, and our system of care needs to adapt. By going directly to them with compassionate outreach and expertise, we are able to help a group that we were missing by relying on a more traditional structure of clinic visits that does not work for everyone.”