In theory, treatment on demand is supposed to reduce the number of these types of episodes, but since 1997, the number of drug and alcohol visits to the San Francisco General emergency room has gone up, while the total number of visits has remained level. Alcohol-related visits have increased by almost a thousand, from 3,373 episodes in 1997 to 4,218 episodes in 1999. Visits for cellulitis have shot from 781 visits in 1997 to 1,436 this year. The numbers have risen in every other substance-related category too, from general opiate dependency to cocaine.
"Treatment on demand," Alan Gelb, chief of the emergency room, says skeptically. "Will you define that for me? Because I see a lot of people who want treatment and can't get it. If you want treatment on demand, then you better be ready to demand real, real hard."
Sonda Andersson Pappan
Anthony Pidgeon
James Stillwell, interim director of Community Substance Abuse Services.
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Gelb's opinion of the city's treatment services seems to be shared throughout the emergency room. Of course, at General Hospital, the staff's job is to catch the people who have fallen down, and the workers have not felt any lightening of the load yet.
Two years into treatment on demand, it may be too early to expect to see results from this potentially groundbreaking program. But with millions of dollars a year, and a piece of the city's quality of life on the line, San Francisco at least deserves a solid game plan and a decent evaluation process from the city's Substance Abuse Services. After all, it doesn't have to be this way.
Baltimore, for example, has taken a different tack. That city, struggling with a drug epidemic as bad as San Francisco's, has chosen a more centralized method of managing its program over our grass-roots approach. San Francisco health officials criticize the Baltimore program for its top-down style, but at least Baltimore is making an effort to be accountable to its citizens.
Baltimore is spending $1 million a year on an extensive three-year evaluation process it began the first year of its treatment on demand program, according to the city's health commissioner, Peter Beilenson. The results are expected to be available in the year 2001. In the meantime, the system is managed by a central body of health officials that keeps close tabs on every one of the program's components, he says, monitoring retention rates and taking urine samples for every type of treatment. Baltimore has spent even more money than San Francisco on its program, hiking its budget from $16 million to $33 million. And as a result, the number of treatment slots has jumped from 4,000 in 1997 to 7,000 today, according to the commissioner. There are still long waits for residential and methadone treatment, but at least the citizens of Baltimore will be able to see the results of their tax dollars at work when the city's treatment evaluation comes out.
What results can San Franciscans expect to see?
"That's a tough one," says Stillwell. "It'll be in the little things. Maybe our parks will be a little cleaner, maybe the line at General Hospital won't be quite as long ...."
