San Francisco, CA – To save lives from overdose, the San Francisco Department of Public Health (SFDPH) is providing unhoused people with immediate medication prescriptions at night and a safe place to begin their recovery.
Under the pilot program, SFDPH provides a real-time connection with a doctor via telehealth to prescribe buprenorphine or methadone for those ready for treatment for fentanyl addiction and other opioid use disorders at night. Medications for opioid use disorder are highly effective and reduce the risk of dying by at least 50 percent.
“It is a top priority of SFDPH to get people with substance use disorders into lifesaving treatment and to support them on their path to recovery,” said Dr. Grant Colfax, Director of Public Health. “This innovative pilot provides unhoused people with highly effective medications and stable and supportive environment to start that medication. Off the streets, participants have the time, space, and resources to plan their next steps toward a healthier life.”
To build on the person’s openness to treatment, and ensure the prescription is filled and the medication is taken, the pilot provides a safe place to sleep that night. The next morning, medical and service support with a caseworker is provided, as well as a weeklong intensive stabilization in certain cases. In the first four weeks of the pilot, during the month of March, more than 55 people started medications for opioid use disorder or entered residential treatment. In total, there were telehealth visits with 173 people and 134 buprenorphine prescriptions issued, with 33% of those prescriptions filled. Nearly a dozen people have entered residential treatment.
“We’re investing in making high-impact treatments such as medications for opioid use disorders available on-demand, said Hillary Kunins, Director of Behavioral Health Services and Mental Health SF. “Our goal is for treatment to be available when people seek care.”
The pilot program is in partnership with Code Tenderloin, the San Francisco Community Health Center (SFCHC), the San Francisco Department for Homelessness and Supportive Housing (SFHSH), and Five Keys.
The SFDPH Night Navigation street care team — staffed by Code Tenderloin — is in the Tenderloin neighborhood every night from 7 p.m. to 3 a.m. outreaching the unhoused population to connect them to shelters and other city services. Under the pilot, from 8 p.m. to midnight, the team connects individuals who say they want addiction treatment with a telehealth doctor who assesses their substance use history and shares the range of treatment options through SFDPH.
If they are interested in starting treatment, the telehealth doctor immediately writes a prescription that is sent to a 24-hour pharmacy or is available for next day pick-up. If they want to start methadone, they are connected to an opioid treatment program for intake. While methadone is heavily regulated and can currently only be dispensed by a licensed opioid treatment program, buprenorphine can be prescribed by any doctor trained in primary care medicine and dispensed from a pharmacist.
“SFDPH continues to move with urgency to bring innovative programs to people ‘where they are’ knowing that addressing substance use disorders requires development of trusting relationships with health care providers and help addressing people’s basic needs,” said Dara Papo, director of a section of SFDPH focused on health care services for people experiencing homelessness.
When accommodations are available, people who want to start treatment are sheltered the same night at a safe space where they can start the medication and receive health care. When available, individuals are placed at the Adante Hotel, an SFHSH-funded shelter where they receive on-site care and services such as case management, medical care, medication delivery, and assistance with Medi-Cal enrollment. The team staffed by the SFCHC and SFDPH works with the individual to create a long-term treatment and housing plan.
"We must be able to meet a person's basic human needs, including shelter, if we truly hope to begin and sustain their treatment for substance use," said Lance Toma, SFCHC Chief Executive Officer. "The feedback from this pilot has been overwhelmingly positive. Our staff is adept at helping people navigate our complex system, and our clients welcome the support and guidance from people who truly care about their wellbeing."
SFDPH provides substance use treatment across its system of care, including at 14 primary care clinics, two urgent care clinics, various community-based health and social service settings (streets, shelters, permanent supportive housing) and approximately 55 specialty behavioral health care clinics. Since the rise of fentanyl-related deaths in 2000, SFPDH is expanding and strengthening its substance use service to make drug treatment more accessible and bring more people into treatment. That includes increasing the number of residential treatment and care beds, expanding access to buprenorphine and methadone through operational hours and legislative action, strengthening linkage services, and establishing street-based behavioral health care and medication initiation.
“We learned early as Night Navigators that there are many people who wanted medication treatment to feel better and begin to recover from their active addiction but were discouraged by the lack of treatment options at night,” said Donna Hillard, Executive Director of Code Tenderloin. “We applaud the Public Health department for recognizing the need for more pathways to treatment at night and launching this pilot. We are seeing the impact every day in the faces of people who view the pilot for what it is: A lifeline out of addiction.”
###