In February 2020, San Francisco was gearing up to open the nation’s first sobering center specifically for people who use methamphetamine. The center — which would take people who are high on the drug off the streets, providing them safety, medical care, and resources — was the primary recommendation of the Methamphetamine Task Force, created in 2019. With the blessing of the mayor, plans were developed speedily to erect a tent in a parking lot of 180 Jones St. in the Tenderloin, with the goal of opening in spring of 2020.
Then, the pandemic hit. Health organizations scrambled, redirecting resources to battling the virus. The opening of the meth sobering center, which was designed to include a large congregate room, was postponed, and 180 Jones St. became a pop-up safe sleeping site.
Now, nearly a year after plans for the sobering center were put on hold, the project has been relaunched. But instead of a tent in a parking lot, The City is looking for a brick and mortar location. And the facility won’t just house the meth sobering center, but also a future safe consumption site — if and when California legalizes a pilot program to open one.
A design challenge
Sobering centers are not a new idea. Since 2003, San Francisco has run an alcohol sobering center, located on Mission Street in SoMa. It takes in more than 5,000 people each year, many of whom are brought in via paramedics. In addition to providing medical support and care, the center makes direct referrals to Joe Healy, an alcohol detox program.
The alcohol sobering center’s design is very intentional. The room can be seen in its entirety through windows in the staff office. Its 12 beds are low to the ground, with mats next to them, so that if someone falls out of one, they won’t sustain serious injuries. Showers and bathrooms are ADA accessible. Nurses are on hand to monitor visitors’ vital signs. All told, most people who are admitted stay six to 12 hours, before being transferred to a detox center or discharged back to the streets.
“When those folks were developing their model [for the methamphetamine sobering center] they asked our in-house experts about what they need to know,” said Alice Moughamian, the alcohol sobering center’s director, noting that many people involved stopped through for tours. “Thinking about what substance people are intoxicated on really impacts how you want to physically lay out your sobering center to make sure people are safe and succeed.”
People who are intoxicated by alcohol have very different needs from people who are high on methamphetamine. In 2019, Dr. Anton Nigusse Bland, San Francisco’s director of Mental Health Reform, toured drug sobering centers in Houston, Texas, Portland, Ore. and Los Angeles for inspiration on design.
“Methamphetamine is what we call a stimulant,” Nigusse Bland explains. “It’s very similar to cocaine, and it tends to cause people to have really erratic behavior. They often feel overheated. And they can be really, really confused and disoriented. On the street, you may see a person that’s pacing, engaging in repetitive motions, talking to someone that’s not really there, maybe yelling at someone because they’re having a surge of emotions. And they’re having delusions that something’s happening to them or that they might be in danger.”
With that in mind, the methamphetamine sobering center being designed in San Francisco will have room for people to pace, and be active. But once they come down, they may feel exhausted, requiring a bed to sleep in for up to a day.
Kathleen Silk is the managing director of behavioral health at HealthRIGHT 360, which will operate the sobering center once it opens. She helped design the first model for the tent at 180 Jones St.
“The plan was a really simple one in terms of having a space for people to be quiet and sleeping, as well as active and having some tactile stimulation and an outdoor area,” she said. Storage would be built for people’s belongings, and bathrooms with showers would be installed. But plans were abandoned when the pandemic hit.
“Because of the affordable housing development slated for 180 Jones St., that location for the drug sobering center was always going to be temporary,” explained Jenna Lane, a spokesperson for the Department of Public Health. “When the pandemic forced us to postpone opening a new congregate setting and to redesign it with COVID-19 distancing in mind, that shortened the amount of time we could use the space at 180 Jones St. enough that it became wiser to look for alternatives. That search continues, and SFDPH looks forward to opening a site that can serve the community for the long term.”
Now, Silk is working with The City to identify a brick and mortar space, and a new design, somewhere in SoMa or the Tenderloin.
“We do still want the model of a larger indoor space where we can have eyes on everybody, and a combination of different levels of activity,” Silk said.
At the same time, there are new concerns about air flow and safety during the pandemic. “With COVID, there’s a ton of other implications, like what type of AC or HVAC system we’ve got going, or the capacity of people,” Silk said. “We had been playing with around 12 to 15 people for beds, or upwards of 20. We’re not trying to overextend ourselves. We run some programs that are like 60 or 70 people. That’s not what this is going to be.”
Bringing people in off the streets
The pandemic provided the time to pursue a more permanent location, but it also gave HealthRIGHT 360 the opportunity to launch its Street Crisis Response Team, which will be a key component in bringing people to the sobering center. The team, which began operating in November, consists of a paramedic, a peer support counselor and mental health therapists. Currently, it only takes calls in the Tenderloin, but the pilot program will eventually be expanded citywide.
According to Silk, “They cannot wait for this to open.”
Intake to the sobering center is being carefully strategized. In addition to the Street Crisis Response Team, HealthRIGHT 360 plans to launch a dedicated outreach team specifically to find people having a hard time with their methamphetamine experience, and a van to transport them to the center. Referrals will also be accepted from EMS-6, The City’s paramedic team dedicated to working with people experiencing homelessness.
“Coerced involvement in this project is not what we’re going for whatsoever,” Silk said. “This has to be totally voluntary. When people are forced or given an ultimatum by law enforcement, their presence in the milieu is really disruptive and not what we’re going for here. We did not want a situation where it’s like ‘this or jail.’”
And, once word gets out, Silk expects people to walk in on their own.
“At its best, this is a program where if I use drugs, I can go there myself,” she said. “I know I can knock on the door, I’m going to be invited in, and I’m going to get the resources I need, and I am not going to be told I have to stay there forever. And if I do want to sleep it off and stay there a little bit, it’s a welcoming community.”
More than just a place to sober up
The creation of a space for people to safely ride out their methamphetamine high is one thing, but creating a route to care is an entirely different beast. People who use opioids — like heroin or fentanyl — have a variety of medications they can choose from to help withdrawal symptoms and reduce cravings. But despite its rapid rise in San Francisco, there are no government-approved medications to treat methamphetamine use, making treating people who are addicted to the drug tricky.
What is available are treatment centers. In San Francisco, many of them are run by HealthRIGHT 360. By operating the Street Crisis Intervention Team, the methamphetamine sobering center, and both inpatient and outpatient addiction services, HealthRIGHT 360 will soon be able to move people through its systems of care fairly seamlessly.
“I think one of our huge strengths for this is that not only do we have those robust programs in the area, but we also know 24-hour treatment,” Silk said. “It’s our bread and butter, and we do it well.”
This means that people who come into the methamphetamine sobering center will not just receive a respite from the streets, but opportunities to receive care — from doctors who specialize in addiction medicine, to residential treatment centers, or even just an appointment with a dentist.
For Silk, it’s also important that staff are trained at every level, from janitors to medical professionals. It’s her goal to make sure that every interaction with people who come in off the streets is as positive as possible. “Wherever people are willing to engage with us, we will do it,” she said.
That commitment to meeting people where they’re at, and addressing their needs in the moment, is a vital key to recovery.
Moughamian, from the alcohol sobering center, says they have people who come in 150 to 200 times a year. “The top 1% of our utilizers are actually 30% of our visits,” she said. Those high-utilizing visitors receive a high level of case management, and are also able to walk in without referrals.
In other words, recovering from addiction requires patience. “It’s important that we acknowledge that recovery is not a linear kind of path,” Nigusse Bland said. “It takes some time. We expect people to want to return here when they’re under the influence, because the other consequences are far worse. We want them to feel this is a safe place to be.”
Moving ahead with a safe consumption site
Opening the first methamphetamine-specific sobering center in the nation is groundbreaking in itself, but San Francisco is already looking ahead. In December, state Sen. Scott Wiener reintroduced legislation to establish a safe consumption site. While it still has to clear the California legislature and Gov. Gavin Newsom’s desk, plans are already developing to combine a future site with the methamphetamine sobering center.
In 2020, 699 people died of drug overdoses citywide.
Silk said a safe consumption site is desperately needed, particularly in the wake of 699 overdose deaths that occurred across the city in 2020. “When people use in secret, they die, and when they use alone, they die,” she said.
But for her, the safe consumption site and the methamphetamine sobering center are just two more resources for people who use drugs to receive the support they need. “I think one of the biggest barriers for people getting into substance use treatment is shame, and stigma,” she said. “If we are showing compassionate, non-judgmental service, we will see a higher rate of people saying, ‘you know, if HealthRIGHT can do this with me, or if Glide can allow me to do this, I can trust them a little bit further and potentially see what recovery could be like.’”
There is no clear timeline on when either facility will open, but the hunt is active. And as for a name? The verdict is out. When the sobering center was slated to open at 180 Jones, HealthRIGHT 360 was toying with the name “Project 180.” Now, the organization plans to open up name ideas for the site to the community it will serve.
That might come sooner than anticipated.
“I have a feeling that a week from now, if we’re able to find the right space, it’ll all be happening very quickly,” Silk said.
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