California's Struggle with Homelessness and Addiction | Saturday Extra

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Georgia Howe: Welcome to Morning Wire. I'm Georgia Howe, and I'm here with our Editor-in-Chief, John Bickley.

John Bickley: Thanks for having me, Georgia.

Georgia Howe: Today, we're discussing California's unique challenges with homelessness and addiction. Joining us is recovery advocate Tom Wolfe. Tom, thanks for coming on.

Tom Wolfe: Thanks for having me.

Georgia Howe: So, Tom, tell us your story. You went from living on the streets of San Francisco to getting clean and off drugs. First, how did you end up on the streets?

Tom Wolfe: So, in early 2015, I had foot surgery, and I was given oxycodone for the pain after surgery, and I got addicted to those pills. And so I started going to the street to continue that addiction to buy those pills on the street. And back in 2015, you could buy oxycodone on the street. Now you can't. It's all fentanyl now.

Georgia Howe: Over the course of two years, you peaked in your addiction to where you were taking about 560 milligrams of oxycodone every day. It was no longer financially viable for you because at the time the pills were $30 each on the street and you were taking seven 80 milligram pills a day. So you were spending $210 a day on pills seven days a week. And I basically went bankrupt. I went broke. I ended up losing my job as a result of my addiction. And then I spiraled into heroin.

Tom Wolfe: Basically my wife had enough. I was kind of terrorizing my family. I was using in the house. I was driving my kids around under the influence of heroin. And she gave me a choice to go to treatment or leave the home. And I opted to leave the home. I chose addiction over my own family. And I ended up homeless, sleeping on the streets of the Tenderloin neighborhood in San Francisco in 2018, where I lived on the streets for six months, chasing my addiction.

Georgia Howe: And how did you end up getting clean?

Tom Wolfe: I was held accountable. I got arrested six times in a three-month period in 2018. At the time, as a way to support my addiction, I started holding drugs for the dealers on the street. I became a mule for them. And they would pay me in drugs. They would pay me with heroin and crack and fentanyl to hold their dope, to hold their stash. And one day, the police were doing a sting on the block I was on, and they caught me holding six gym socks full of drugs for the dealers. And I went to jail the first time. I was released 16 hours later on my own recognizance back into homelessness and I repeated that cycle five more times over a three-month period until the last time I got arrested and they were like, you have been arrested too many times, you have too many cases, too close together. And I had to spend three months in county jail where I got clean and then I was offered an opportunity to go to the Salvation Army, to go to residential treatment here in San Francisco and I did for six months and that's why I found recovery and I've been clean and sober ever since now over five years.

Georgia Howe: Now, what do you think was the biggest factor in you making it? I understand when it comes to opioids, the relapse rate is very high. Why were you able to stay clean?

Tom Wolfe: I don't know. I mean, look, recovery for a lot of people is a spiritual journey. So I found some spirituality. I found God is part of my process for recovery. That sounds kind of cliche, but it's true. Also, I was tired. I was 48 years old when all that happened. I mean, I got addicted at 45. And so here I was at 48 years old and my public defender's trying to get me on SSI in jail saying I'm basically retired and I'm like, I'm only 48 years old, my life isn't over yet. And so I just decided that I was gonna give recovery an honest try. Plus, I hadn't seen my kids in months and months and I ended up not seeing them for about a year and a half total. And so there was something to work towards. And so I thought if I gave recovery an honest try, I could maybe find a way back to them, but I knew that there was no pathway back to them if I stayed on the street.

Georgia Howe: Now, just before we move on, were you able to reconcile with your family?

Tom Wolfe: I was. So it took a couple of years of intense family therapy and counseling. I had to be reintroduced to my kids in sobriety. It's something that I'm very open about. I went through a lot of counseling with my wife and my wife is a saint because she gave me another chance and I moved home a couple of years ago and I'm with my wife and kids and we as a family live together in recovery. We live by the principles of recovery as a family and it's working out really, really well. And now I'm thriving, my wife is thriving and my kids are pulling straight A's in school right now and they're doing really, really well.

Georgia Howe: I'm glad to hear that. So I wanna ask you about some of the policies that are in place in California and some that are being floated because it sounds like you'd have an interesting perspective there. So for example, the CARE Act just went into effect in California at a state level this week. For listeners, that's a new provision that would allow family members and some other healthcare professionals to petition a judge to prescribe a court-ordered care plan for severely mentally ill homeless people. So I'm not sure if addiction falls into that category. What can you tell us about the CARE Act? Are you hopeful about it? What are the pros and cons?

Tom Wolfe: Well, so addiction, severe addiction has now been added into the CARE Act as one of the provisions. So that's new. The way I look at it is this is a baby step in the right direction. I'm skeptical of Governor Newsom's plans in general around this area because he's also supported decriminalization and reducing penalties for fentanyl dealers and things like that. But you can't deny the fact that we have almost 200,000 homeless people in the state of California alone, which is almost half of the population of the homeless population of the whole country. And if 80% of them, which according to a UCLA study in 2019, are struggling with addiction or untreated mental illness, then yeah, we need to start taking some steps. So while I'm cautiously optimistic about this new effort, and I'm happy that it's a step in the right direction, there's still a ton of infrastructure that has to be built out to be able to support these changes. So while it sounds really good on paper, again, implementation is always different, and we lack a lot of infrastructure to support these proposed changes.

Georgia Howe: Now, if you were in Gavin Newsom's shoes, what would you do?

Tom Wolfe: Well, first I would start by passing Alexander's Law, which is an admonishment that holds fentanyl dealers to account that basically says, if you continue to get convicted of selling fentanyl and we can prove that someone died of an overdose from the drugs that you sold, we can charge you with murder. I think fentanyl has changed the game. So I really think that we need to impose some additional penalties for people that are making the conscious decision to sell a drug that's killing two people a day in San Francisco. I would also start with thinking about a massive statewide effort to support addiction treatment and mental health treatment maybe even a statewide agency that oversees addiction and mental health treatment for the whole state of California which would help kind of build out a whole system to support all these folks. If 80% are struggling with addiction or mental illness, and there's 200,000 homeless people, how many mental health beds do we need and how many drug treatment beds do we need? We need thousands, thousands of them. And we're so focused on just housing first and building more housing that we're kind of putting the cart before the horse. Because right now what you're seeing is in places like San Francisco, where we're placing people that were chronically homeless into housing, we're seeing that 70% of all the overdose deaths that are happening every month in San Francisco right now are happening at a fixed address. And most of that is inside permanent supportive housing. So it's not really working out the way it was intended, which means we need to create more options or enlarge the solution space so that we can have more options for people.

Georgia Howe: Now, one thing that comes up when you mentioned building out more drug treatment beds or even a whole agency to address this, I would wonder just from your perspective, do you think we have a good method for treating addiction? Even if California had those unlimited funds to build and staff those beds, which of course is a big if, do you think we actually have a reliable formula that would work for most people?

Tom Wolfe: There are formulas out there that work and they start with something called building out a continuum of care. It starts with treatment on demand, which means that when someone's ready to go to treatment, within three hours, you have that person in a detox bed starting that process of detoxification. And that moves on to residential treatment and then into transitional housing so that someone has a clean and sober place to live where they can really get their feet under them and maybe get a job. And then they can move into independent living and reintegrate into society. That is the process that would work. What we don't have is one, we don't have enough detox beds. San Francisco only has 57 detox beds in the entire city that are funded by public health. And we have 25,000 drug users in San Francisco. And then when people complete treatment, They have nowhere to go except for one of those SROs. And unconfirmed reports suggest that people that are in recovery that move into this permanent supportive housing in San Francisco, which is usually just an old hotel that's been converted, the relapse rates hover around 90% right now. That's not recovery.

Georgia Howe: Now, let's move on to another proposal being floated in San Francisco. The mayor just announced that she wants to limit or end certain cash handouts or at least have them contingent on drug testing and treatment. Tell us about that proposal. Do you think something like that could get past the city council? And how do you think citizens would feel about it?

Tom Wolfe: It's funny because London Breed is famous for talking tough and then not actually following through with the things that she says. This is specific to the people that do not have kids. Single indigent men and women that are applying for cash assistance in San Francisco. The idea that she floated would be that we would assess them. And if they're struggling with addiction, they would have to take a drug test. And if it tests positive, they would then have to actually access drug treatment before they could collect that money. It has been since amplified that message to basically state that they would only do that if the person appears to be on drugs or openly admits that they're on drugs. So if I'm homeless, like I used to be, and I went and signed up for GA, which I did, and they asked me if I was on drugs, my answer would be, what drugs? What are you talking about? I'm just a guy down on his luck. So we have to kind of be realistic and understand that this was just a political stunt. London Breed is in a re-election fight right now. She has two people that are running against her including Daniel Lurie who one of the heirs to the Levi Strauss fortune that just announced he's running So she has some stiff competition for mayor So of course she's going to say those things But again saying a plan out loud and then implementing the plan are always two different things. And no, I don't think it has a chance of passing the city council or the board of supervisors here in San Francisco. She just maybe has four of the 11 on the board that would support her. She needs six. So I don't really see it going anywhere.

Georgia Howe: Now, returning again to your experience, obviously you were previously an addict. I assume that meant you interacted with all walks of people who were also addicts who found themselves in that similar position on the streets. In your experience, how are most people getting hooked? Where is it starting?

Tom Wolfe: It starts before homelessness for most people that I've seen, right? You know, it's like me. You had an accident, so they give you pain pills and you get hooked. You maybe got a football injury when you were in high school and you started using and you get hooked. The thing that's sad about all of this really is that in 2017, 2018, when I was out there, heroin was the predominant drug of choice along with crystal meth. Since 2018, heroin has disappeared from the streets of San Francisco. So now all you can buy is fentanyl. That's it, which is 10 to 100 times stronger than heroin. And so people that were already homeless on the street using heroin, they almost kind of didn't have a choice but to switch to fentanyl because the drug dealers didn't have anything but fentanyl. And so now they've really compounded the problem as a way for them to just make more money because fentanyl is such a cash cow.

Georgia Howe: You have to think about it, right? Cartels that smuggle in the fentanyl, they used to have to grow opium poppies and harvest them and turn them into heroin. They don't have to do that anymore. They just take three precursor chemicals that get smuggled in from China to Mexico, combine them together to make fentanyl, they turn it into a powder or pill form, and then they smuggle them by the metric ton into the United States for distribution. And that has created a scenario where we have 17 to 20 million people struggling with addiction in the United States and 110,000 overdose deaths a year, whereas in 2010, for example, the United States had 17,000 overdose deaths. So the OD deaths have grown by almost a factor of 10 during that time. And we don't seem to be really interested or willing or prepared at the national level, at the federal level, and at the state level to do anything to mitigate all those drugs that are coming across our borders.

Georgia Howe: And then you have to start asking about why are so many people, new people, actually just kind of falling out of society and getting addicted to these drugs and ending up on the street. If you were to make a guess, just a ballpark, what percent or how many out of 10 would you say started with a situation like you where their first experience with an opioid was from their doctor?

Tom Wolfe: Eight out of 10. Wow. I would say so, yeah. I mean, look, there's people that are on the street that were meth addicts and cocaine addicts that are now fentanyl addicts too. And that's because the drugs on the street got contaminated, I think accidentally on purpose by the cartels in which they actually started adding fentanyl into the cocaine, adding fentanyl into the meth. So even if maybe you weren't interested in getting addicted to fentanyl, well, if you weren't three years ago, you are now. You're addicted to fentanyl. And so now you're like literally a slave to that drug because you have to use it every two hours. It's not like heroin where you could shoot up some heroin and you're good to go for six to eight hours. With fentanyl, you have to use it every two hours. And that just makes it like almost impossible to reach a point of clarity that you want help on the street, which is why I advocate for intervention for a subset of those people that are on the street. They need it or they're going to die.

Georgia Howe: All right, well, Tom, this is such an important issue and I really appreciate you coming on and getting information out there.

Tom Wolfe: Oh, it's my pleasure. Thanks for having me.