A Path to Recovery

References

1. Assessment of Annual Cost of Substance Use Disorder in US Hospitals. Peterson,C. Li, M. xu,L. Mikosz, C. Luo, F. JAMA 2021;4(3): e210242.

2. Brain-Wide functional architecture remodeling by alcohol dependence and abstinence. Adam Kimbrough https://orcid.org/0000-0001-9434-4987, Daniel J. Lurie, Andres Collazo, and Olivier George olgeorge@ucsd.e.

PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES

Vol. 117 | No. 4, January 28, 2020

3. Deinstitutionalization of People with Mental Illness: Causes and Consequences. Virtual Mentor. 2013;15(10):886-891. doi: 10.1001/virtualmentor.2013.15.10.mhst1-1310.

4. Bring Back the Asylum Dominic A. Sisti, PhD1; Andrea G. Segal, MS1; Ezekiel J. Emanuel, MD, PhD1 JAMA 2015;313(3):243-244. doi:10.1001/jama.2014.16088

5. Treffert, DA. 1973. Dying With Their Rights On. American J. Psychiatry 130(9):1041.

6. When homelessness and mental illness overlap, is forced treatment compassionate? April Dembosky, Amelia Templeton, Carrie Feibel NPR . March 31, 2023 https://www.npr.org/sections/health-shots/ 2023/ 03/31/1164281917/when-homelessness-and-mentalillness-overlap-is-compulsory-treatment-compassiona

7. My Son Was Addicted and Refused Treatment. We Needed More Options. David Scheff, New York Times, April 12, 2023 https://www.nytimes.com/2023/04/12/opinion/addiction-treatment.html

8. Hospital Standards for People with Substance Abuse Disorder. NEJM 387;8 August 25, 2022. pp 672-675

9. Health Serv Res. 2006 Feb; 41(1): 192–213.

Our current approach to San Francisco’s most vulnerable citizens is well intentioned, costly, and insufficient. There is the sense that we have an orchestra of musicians each playing without the benefit of a conductor. Solving this problem of the most vulnerable will require close coordination at every level, from the hospital admission through inpatient rehabilitation and longterm residential recovery. We must work in harmony, or we will continue to fail.

The individuals we propose to address are defined as: those who suffer from medical conditions, especially substance use disorders, severe enough to require hospitalization, but, due to substance use or psychiatric disorders, repetitively demonstrate a lack of capacity to understand the nature of their disease, the recommended treatment, or the consequences of non-compliance.

Five Recommendations:

1) Harm Reduction

Control of the drug supply must be accompanied by other harm reduction strategies such as overdose reversal, syringe exchange, and safe injection settings, all linked wherever possible to quality substance use disorder treatment without delay.

2) Stabilization

Formal clinical services, reflecting best practices in Addiction Medicine and Psychiatry, should be established at every local hospital, with coordinated linkage to longer-term treatment settings.

3) Conservatorship

We should reform the criteria and process to allow for patients who meet our criteria to be placed into a residential treatment facility for their conditions in a timely manner. This can be achieved with adequate protection of their well-being, until they are evaluated as being able to function safely in the community.

4) Placement

San Francisco should provide an appropriate residential facility for this specific subset of patients where they can continue to receive necessary medical and psychiatric care along with appropriate rehabilitation services.

5) Funding

Redirection of existing funds could offer a more expedient way to rapidly advance the goals of this plan. New sources such as public bond funding and targeted taxes or fees on legal addictive substances and/or other sources should also be considered.