S.F. surpasses deadliest year for drug overdoses. This is the grim toll

Fatal overdoses have risen at especially alarming rates among Latino and Black people, the latest figures show.

San Francisco has surpassed its deadliest year for accidental drug overdose deaths, a dreaded milestone reached a month before the new year and propelled by the prevalence of fentanyl.

In the first 11 months of 2023, San Francisco recorded 752 deaths, newly released data from the medical examiner’s office indicates. That’s 26 more than the previous peak of 726 deaths in all of 2020. Deaths recorded in December will drive this year’s total higher. 

Accidental overdose deaths have climbed in 2023 despite efforts by Mayor London Breed and Gov. Gavin Newsom to disrupt the drug trafficking market and crack down on dealers. The grim toll highlights the challenging task of reining in a crisis fueled by fentanyl, a synthetic opioid up to 50 times stronger than heroin and a drug that is also sometimes taken in conjunction with other drugs.

“The fentanyl crisis is a national crisis,” said Dr. Hillary Kunins, director of San Francisco’s Behavioral Health Services, during a Thursday news conference at the Department of Public Health. More than 80% of San Francisco’s accidental overdose deaths this year have involved the powerful substance, data shows.

“We are not alone, and I’d characterize our current period with some uncertainty,” Kunins said about whether the city would continue on an upward trajectory of overdose deaths.

In November, the most recent month for which data is available, 57 people died of drug overdoses, down from 65 in October. August was the city’s deadliest month on record, when 87 deaths were recorded, according to the data. The monthly numbers remain preliminary and sometimes increase or decrease slightly with further investigation by the city’s medical examiner.

recent examination of death reports by the Chronicle revealed that a rising number of people who fatally overdose in San Francisco have both fentanyl and a stimulant in their systems — a trend that some researchers are calling a “fourth wave” of the overdose epidemic.

Breed has called for a more “aggressive” approach for people struggling with fentanyl addiction and directed police to arrest more drug users and dealers. Critics have blasted the mayor for shifting toward a heavier reliance on policing to address what they argue is a public health crisis. 

Many of those same critics have pressed the mayor to open a supervised drug-use site in San Francisco — a model used in cities around the world and in New York to prevent overdose deaths — but the mayor is hesitant because it’s illegal under state and federal law. The city’s controversial Tenderloin Linkage Center, which provided such a space, was open for about a year before closing in December 2022.

Jhase D. White, who is living outside in the Tenderloin, said he started smoking fentanyl about two years ago. Since then, he said, he remembers experiencing at least one overdose, which a friend reversed using naloxone, commonly known by its commercial name Narcan. He also was arrested by San Francisco police for open drug use, but that didn’t stop him from using. 

White said he got hooked on opioids following several motorcycle crashes that left him in pain. After losing his job and apartment, he switched from painkillers to fentanyl, he said. 

“Ultimately, I just need a better quality of life and have some inspiration to live healthier,” he said, adding that he’d like to get clean but doesn’t know how. 

Earlier this year, Newsom brought in the California National Guard and state police to partner with San Francisco police to curb fentanyl trafficking downtown. 

In October, the governor and Breed launched a new task force to begin investigating opioid-linked deaths similarly to homicides. Then last month, Newsom proposed a ban on xylazine, a veterinary tranquilizer turned street drug known as “tranq.” Xylazine has contributed to 30 accidental overdose deaths in San Francisco this year, according to the data from the medical examiner.

Fatal overdoses have risen at especially alarming rates among Latino and Black people, the data shows. Between January and November, 140 Hispanic people died from accidental drug overdoses, a 63% increase from the same period in 2022. About 230 Black people died from overdoses during the 2023 period, a 47% jump from 2022. The number of white people who died from overdoses rose 4% between the two periods, from about 270 to 280.

Facing a competitive reelection campaign next year, the mayor placed a measure on the March ballot to mandate drug screenings and treatment for San Francisco welfare recipients struggling with addiction.

Click here to read the full article in the SF Chronicle

Newsom’s plan to crack down on flesh-eating ‘zombie drug’ known as ‘tranq’

SACRAMENTO, Calif. – California Gov. Gavin Newsom announced Tuesday that he will sponsor a bill to increase penalties for trafficking the deadly, flesh-eating animal tranquilizer, xylazine, more commonly known as “tranq.”

Although Newsom rarely sponsors bills, he said that this action was necessary in combating the increasing overdose deaths across the state caused by the drug.

“Tranq poses a unique and devastating challenge in our fight against the overdose epidemic,” said Newsom in a statement. “Although California is not yet seeing tranq at the same rates as other parts of the country, this legislation will help the state stay ahead and curb dealers and traffickers, while we work to provide treatment and resources for those struggling with addiction and substance abuse.”

Xylazine is not approved for human consumption, according to the FDA. It can cause dangerously low blood pressure, a decrease in breathing rate and heart rate, and damage to tissue that can lead to skin wounds, large sores and ulcers when consumed by people, authorities say.

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Additionally, the Drug Enforcement Agency (DEA) says xylazine is increasingly being mixed with fentanyl, making it even more dangerous.

Click here to read the full article in Fox 11

‘El Mago,’ drug trafficker linked to son of Sinaloa cartel kingpin, gunned down in L.A.

A convicted drug trafficker linked to the Sinaloa cartel who worked for the son of Joaquin “El Chapo” Guzman was gunned down Thursday morning in an industrial stretch of Willowbrook, according to authorities and court records.

Eduardo Escobedo, 39, was one of two men killed in the 14200 block of Towne Avenue, according to officials from the Los Angeles County Medical Examiner and Los Angeles County Sheriff’s Department. The other victim was Guillermo De Los Angeles Jr., 47.

Around 8 a.m. Thursday, sheriff’s deputies responded to an industrial area filled with warehouses, including a truck yard, pallet storage facility and a church. Escobedo and De Los Angeles died at the scene. A third man was taken to a hospital with non-life threatening gunshot wounds.

“It appears that there was some type of gathering or party at the location from last night to early this morning,” Lt. Omar Camacho told KABC-TV Channel 7 at the scene.

Escobedo, whose nickname, “El Mago,” translates to “The Magician,” served four years and nine months in federal prison for conspiring to distribute more than 10,000 kilograms of marijuana and laundering drug proceeds. He was released in 2018.

Raised in East Los Angeles, Escobedo rose to become the primary distributor of marijuana in Los Angeles for Guzman’s oldest son, Ivan Archivaldo Guzman Salazar, a prosecutor said at a 2014 detention hearing. He laundered the proceeds in part by buying exotic cars and shipping them to Culiacan, the capital of Sinaloa and the cartel’s stronghold.

Escobedo was also alleged to have ordered the death of a rival trafficker who was gunned down in his Bentley on the 101 Freeway in 2008. While Escobedo was never charged in the murder, his brother and another man were convicted and are serving life sentences.

Escobedo was born in the United States, his lawyer, Guadalupe Valencia, said at the detention hearing. He attended Garfield High School, where he met his wife, and later graduated from a continuation school, Valencia said.

In July 2011, Escobedo, then 27, was arrested leaving a stash house where police found a ton of marijuana, Adam Braverman, an assistant U.S. attorney, said at the detention hearing. Torrance police, which served the warrant, said the stash house was in the West Adams neighborhood.

In October 2013, Escobedo was caught on a wiretap speaking with Guzman Salazar about smuggling more than five tons of marijuana through a tunnel under the U.S.-Mexico border, Braverman said. Authorities seized 2.7 tons of cannabis from a courier working for Escobedo, according to the prosecutor.

Guzman Salazar remains one of Mexico’s most wanted men. One of his top lieutenants, Néstor Isidro Pérez Salas, nicknamed “El Nini,” was captured by the Mexican National Guard earlier this week in Culiacan. Justice Department officials are seeking to extradite Pérez Salas, who is charged in two U.S. jurisdictions with conspiring to traffic methamphetamine, fentanyl and cocaine; laundering money; retaliating against witnesses; and possessing machine guns.

Escobedo was also helping Guzman Salazar launder money through the purchase of sports cars that were shipped to Culiacan, Braverman said. Federal agents determined that Escobedo used a false name to buy two Lamborghinis from a dealership in Newport Beach.

Braverman said Escobedo was stopped by the Irwindale police driving one of the cars, a $175,000-dollar Murcielago. The Lamborghini was purchased with a series of cash deposits just beneath the $10,000 threshold that triggers a bank reporting requirement, according to a warrant for the car’s seizure.

Agents listened on a wiretap as Guzman Salazar asked Escobedo to purchase a Nissan GTR and make $50,000 in modifications, Braverman said. Mexican authorities seized the Nissan in Culiacan in 2014, as well as a McLaren that Escobedo had bought in California for $175,000, the prosecutor said.

At the time of his arrest in 2014, Escobedo was living in a sprawling Granada Hills home with a pool and tennis court. Drug Enforcement Administration agents searched Escobedo and found him carrying a large amount of cash, four phones and keys to five different cars.

A father of four, Escobedo claimed his annual income of about $200,000 came from a business he owned with his wife, International Hair Authority, that imported hair extensions and sold them. Escobedo also reported owning a record label, Magic Records Corporation.

Braverman said agents suspected Escobedo was using the hair company’s accounts to launder drug money, pointing to a $50,000 wire transfer from a man named Harvinder Singh. Scotland Yard, the London police force, arrested Singh and his associates, who were shipping cocaine from Mexico to London on British Airways flights, Braverman said.

After pleading guilty to conspiring to distribute marijuana and launder money, Escobedo was sentenced to 57 months in federal prison.

He was never charged in a murder that sent his younger brother to prison.

In 2008, police found a bullet-riddled silver Bentley Continental GT crashed on the center median of the 101 freeway in downtown Los Angeles. Jose Luis Macias, 25, was slumped behind the wheel. A bullet had gone through the back of his head.

Nicknamed “Huerito,” Macias worked for the Arellano Felix organization, a Tijuana-based cartel that rivals the Sinaloans. Macias’ friends often got into fights with Escobedo’s brother, Andy Medrano, at a Pico Rivera nightclub called El Rodeo, according to an appellate decision that summarized the evidence in Medrano’s trial.

In the early morning hours of Dec. 12, 2008, Macias was at a festival for the Virgin of Guadalupe on Olvera Street when he got into a fight with Medrano and a friend, Michael Aleman, a witness testified. Security guards broke it up.

Macias was waiting at a red light in his Bentley when two men approached the car on foot, a witness testified. The witness, a stranded motorist waiting for a tow truck, saw muzzle flashes erupt in quick succession, as if from automatic weapons. The Bentley made a U-turn and sped toward the freeway.

Police suspected Escobedo had ordered the killing. According to a search warrant affidavit reported by The Times in 2009, detectives believed he and Macias were engaged in “a power struggle” over control of trafficking networks.

At the 2014 detention hearing in federal court, Braverman said Los Angeles detectives suspected Escobedo “ordered the homicide to occur.”

“Our understanding is that individual was a rival drug trafficker driving in that Bentley,” he said.

Detectives arrested Escobedo in 2011 and questioned him about the homicide before letting him go. Valencia, his attorney, said Escobedo was subpoenaed to testify, but was told by a prosecutor he wasn’t being called as a witness in the trial. His brother and Aleman were convicted of Macias’ murder and sentenced to life terms.

After his release from federal prison in 2018, Escobedo opened a chain of restaurants and food trucks called Benihibachi, according to a motion his lawyer submitted to terminate his probation early. The motion included a photograph of Escobedo wearing a shirt with the restaurant’s logo, chopping a tub full of onions.

His attorney, Ezekiel Cortez, urged the judge to see the good Escobedo had done after leaving prison. “As a society, you recognize that they listened. You recognize people who turned their lives around,” Cortez said at a hearing. “You recognize people who cut their ties, as in this case, with former very bad associations.”

“Mr. Escobedo proved to the whole word that he cut his ties completely,” Cortez said. “And he acquired some risks.”

Calling Escobedo “an enormous success,” U.S. District Judge Dana M. Sabraw agreed to terminate his probation early. “Free from these influences,” Sabraw said of Escobedo’s ties to drug traffickers, “you are a very productive, wonderful human being.”

Still, Escobedo flaunted his opulent lifestyle on social media in recent years. He posed for photographs with Floyd Mayweather and Al Pacino. He wore flashy tracksuits by Dolce and Gabbana and sported a diamond-encrusted Richard Mille watch. One photograph showed Escobedo holding a duffel bag full of money. In another, he embraces a member of the Mexican Mafia while holding a bottle of Dom Perignon champagne.

In a corrido, or ballad, titled “El Mago,” the group Edicion Especial sang that Escobedo had changed for the better. “A long time ago it was different,” the song goes, but today he has “los gringos” eating at his Japanese restaurants. He thinks often of his brother, “the one who is in prison.”

Click here to read that the full article in the LA Times

The New Plan For Psychedelic Drug Decriminalization In California

Senator Wiener to work with Republicans on a limited therapy-only focused bill

The potential legalization of certain psychedelic drugs in California continued to take more odd turns in the past few weeks, with Senator Scott Wiener (D-San Francisco) recently announcing a new plan: working with Republicans to create a bill that would keep both sides happy.

For several year, psychedelic drugs such as psilocybin (magic mushrooms), dimethyltryptamine (psychedelic drug DMT), ibogaine (psychedelic substance), and mescaline (psychedelic hallucinogen) have been close to being decriminalized in California. Senator Wiener led the charge beginning in 2021, introducing SB 519 to the state Senate. While the use of psychedelics in helping combat PTSD and other afflictions has been seen more and more positively over the years, the ever present negative effects of the drugs had largely ended any real legalization effort.

However, Wiener used a combined approach with SB 519, writing the bill as a way to end the mass incarceration that occurred during the war on drugs, as well as to increase scientific and medical testing to help those suffering from mental health conditions such as PTSD and depression. Early opposition forced Wiener to continue to amend the bill. All synthetic hallucinogens were removed to make the bill more palatable, removing lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy, molly). Other troubling drugs such as ketamine and peyote derivatives of decriminalized mescaline were also taken out, with the bill ultimately being gutted almost completely, removing everything but a single study on the use of the remaining drugs. While bill fizzled out in the Assembly, it did manage to narrowly pass the Senate, leading to Wiener to try again this year.

Introduced as SB 58 earlier this year, Wiener focused on only plant-based psychedelics in the bill. This version proved far more successful. While opposition against the bill was still high, his changes managed to win many lawmakers over. In the Assembly, it passed 43-15, but with a much larger than usual 22 Assemblymembers choosing not to vote. The bill then went to the Senate again because of the number of amendments being made since May. There it was finally passed with a 21-14 vote, but with 5 abstaining, with the bill being sent to the Governor in September.

But, despite Governor Newsom expressing support for psychedelics for the use in medical treatments in the past, Newsom ultimately vetoed the bill. While a set back, Newsom left a door open for Newsom and supporters, saying that he would support such a bill if it had therapeutic guidelines and made clear that decriminalization was for medical use only. Wiener immediately vowed that a new bill would be in place for 2024 with such guardrails in place.

That was until a near hijacking and crash of an Alaskan Airlines flight late last month by a pilot who had previously taken magic mushrooms put another damper on legalization efforts, highlighting the dangers of using them to the public once again. Now faced with even more opposition, Senator Wiener announced recently a new way forward – bipartisanship.

As it turned out, Assemblywoman Marie Waldron (R-Escondido) has had a similar bill in the Assembly for most of the year – AB 941. However, the bill severely limits how psychedelics could be used. Essentially, only licensed clinical counselors can administer psychedelic substances to combat veterans suffering from issues such as PTSD as part of a wider-scoped therapy. While the bill is currently halted after not so much a hearing, AB 941 drew immediate interest from Wiener following his bill failure due to it not only meeting Governor Newsom’s request for guidelines and making it medicinal only, but also because of support from at least some Republicans due to it being limited to a clinical degree to only veterans.

Wiener, Waldron team up for new bill

With Wiener still wanting some sort of legalization in place and Waldron wanting better therapy for veterans, both teamed up for a bill due to come out next year. As they have worked together on dozens of bills in the past, the team up happened with relative ease.

“Per the governor’s message, our bill will focus on providing access to regulated psychedelic therapies administered by licensed and vetted facilitators,” said Wiener earlier this month. “The question of decriminalizing personal use & possession will be left for subsequent efforts.”

Waldron, meanwhile, has been adamant about wanting to gather research data on psychedelic therapy for veterans, adding that “There’s been some success with psychedelic therapy in clinical settings with professionals who have the proper training. Many of them say they don’t have those thoughts anymore. If we could save lives, that’s what it’s all about.”

Both also noted that they will be looking at Colorado’s new psychedelics law for some framework.

Experts told the Globe on Friday that what Wiener and Waldron are saying about a new 2024 bill his completely in line with what medical experts, psychedelics supporters, and those opposing psychedelic decriminalization have been saying for years: that it needs to be medically tested and focused on therapy first.

“We’ve been saying that that should be path for years,” said former police officer and current drug counselor Marty Ribera. “Wiener kept pushing decriminalization, but most people, including the Governor, don’t want that. What the majority of the public does support right now is that it be used in therapy in a very limited capacity with proper guidelines. Waldron was on the money this year in focusing on veterans.

Click here to read the full article in the California Globe

Addiction Counselors Say Fentanyl Is Now In Most Drugs. It’s Replacing Heroin in Stanislaus Region

The New Hope Recovery House in Modesto used to treat heroin addicts, including people who first got hooked on prescription narcotic painkillers and then sought heroin to prevent withdrawal pains. That was a syndrome of the earlier stages of the nation’s opioid epidemic. Now, heroin has disappeared. And many are seeking treatment for addiction to fentanyl, said an intake counselor at New Hope. “No heroin addicts are coming in,” Counselor Theresa Frassrand said. “You can’t find heroin because the fentanyl is so prevalent.” Staff members at New Hope on East Orangeburg Avenue were among the first to alert media, in June 2020, that fentanyl had arrived on Modesto’s streets. Illegal fentanyl resulted in 5,961 overdose deaths in California in 2021. In the past three years, co-owner Shawna Phillips and substance use counselors have watched the highly lethal fentanyl become widespread in Stanislaus County. The synthetic opioid powder is combined with most illegal drugs including methamphetamine, cocaine, pills and any available heroin, supposedly to enhance the high and reduce the cost.

“Marijuana is testing positive for fentanyl,” Phillips said. Only about 2 milligrams of fentanyl is lethal, which accounts for the 366 fentanyl overdose deaths in Stanislaus County since 2020, including more than 80 since January. Total overdose deaths are expected to exceed 200 in 2023, or four to five per week. New Hope Recovery has residential care for 30 people, outpatient counseling and detox service, and stresses one-on-one counseling that gets to the root of substance use. About 70% of the clientele suffer from alcohol dependence. Of those addicted to drugs, staff said, half were taking methamphetamine and half were on fentanyl, whether they knew it or not. Frassrand said some people who come through her intake office don’t know the drugs they were taking contained fentanyl, until they test positive for it. LAB COULD NOT TEST FOR ‘TRANQ’ Phillips was preparing last week for the latest scourge of the Central Valley fentanyl crisis. The lab used by New Hope could not test for “tranq”, which surfaced in Stanislaus County two months ago, but Phillips arranged for a Southern California lab to test clients’ urine samples for the drug. Xylazine combined with fentanyl, also known as tranq, causes skin lesions and severe infections in those that inject the drug. Users suffer the loss of mental function, and xylazine, a horse tranquilizer, does not respond to overdose-reversing Narcan nasal spray. Phillips said she hasn’t seen anyone who has used tranq come to the center for help. “It’s limited now, but I think it’s coming,” she said. Phillips said some clients have knowingly used deadly street fentanyl and are trying to break the addiction. “I ask them ‘does it not terrify you?’” Phillips said. “What they say is it lasts longer and is so much cheaper. A lot of them are injecting it. When they are knowingly using fentanyl, they are usually IV users.” FENTANYL USERS MUST OVERCOME INTENSE CRAVINGS Clients hoping to get clean struggle with the intense cravings of fentanyl use. Phillips said those going through detox have agonizing withdrawal symptoms, and staff need to give them stronger medication to treat the effects. People who leave treatment prematurely run a high risk of using again, so the center works harder to motivate them to stay in treatment, Phillips added. Amy Northern, 42, of Modesto, who’s in counseling at New Hope, said she didn’t have a choice in switching from heroin to fentanyl. The heroin supply dried up. And she didn’t want to suffer severe withdrawal pains, she said. Northern said she overdosed on fentanyl a number of times and was taken by ambulance to hospitals. She has been clean since January and gets support from outpatient classes at the center. “If I go back on it again, it will kill me,” Northern said.

The staff at the community-oriented treatment center are well aware of tragedies of former fentanyl-addicted clients who relapse. “We stay connected with patients and their families and we have been invited to more funerals or received phone calls about people we know who passed away,” Phillips said. Many people working in the addiction field, who often have a substance use background, have lost family members to fentanyl, she said. FENTANYL COMBINED WITH MANY DRUGS Stanislaus County recorded some fentanyl deaths before 2020, including 16 in 2019 and 10 in 2018. Illegal manufacturing of the synthetic opioid was a later development of the national opioid crisis that sprang from over-prescribing of narcotic pain medication. Fentanyl became more prevalent here in 2020 with fake pills made by drug traffickers to look like oxycodone, Xanax and other prescription drugs. The county’s 60 fentanyl overdose deaths in 2020 grew to 97 in 2021 and 128 in 2022. Drug traffickers are now combining fentanyl with many other drugs and don’t have standards to keep the fentanyl content within safe limits. As fentanyl continues to run rampant, the New Hope staff are trying to maintain the center’s success rate, which they boast is well above the national average. Phillips said there are substance use resources in the community but not enough coordination to help people find those services. Recovery services run into problems in getting private insurance to cover treatment for addiction. “A lot of people can’t stay clean on their own,” Phillips said. “They need to learn abstinence and need a period of time to stay clean. Insurance usually covers 30 days of residential care before it steps down to outpatient classes. Longer treatment has been proven (to achieve) better outcomes.”

Click here to read full article in the Modesto Bee

How California Is Fighting Meth With Gift Cards

Among the most difficult addictions to witness at San Francisco general hospital’s drug clinic is methamphetamine, which leaves users tearing at their skin and unable to eat, sleep or sign up for help.

The worst part: The clinic workers largely are powerless because unlike with opioid addiction, for which doctors prescribe medications such as methadone, there is no medicine for stimulant use disorder.

“We live day in and day out watching people suffer in a way that’s hard to imagine,” said Dr. Brad Shapiro, medical director of the Opiate Treatment Outpatient Program at Zuckerberg San Francisco General Hospital. “They’re just dying in front of us.” 

Faced with that immense suffering, California will try a new approach to stimulant addiction: Paying people with gift cards to reward them for staying sober. 

This model, known as “contingency management,” rewards people with financial incentives each time their drug tests are negative for stimulants. It’s been shown to have success in clinical trials — and the U.S. Department of Veterans Affairs has been using it for more than a decade — but it hasn’t taken off in California. Medicaid previously wouldn’t cover it, so there was no funding to expand its use.

To Shapiro, that’s inexcusable. 

“It’s actually, in my opinion, really quite criminal that we’ve gone decades knowing this is an effective treatment and the powers that be have failed to make a pathway for treatment for people,” he said.

The program is expanding now, thanks to a recent waiver by the federal Centers for Medicare & Medicaid Services that allows the agency to cover its costs. California was the first state in the nation to win approval for a contingency management program under Medicaid. The Golden State is launching pilot programs in 24 counties, including San Francisco, Sacramento and Los Angeles. Costs for what collectively is called the Recovery Incentives Program will be reimbursed by CalAIM – the state’s recent expansion of Medi-Cal services.

“All of a sudden we have money to provide this incredibly effective intervention,” said Shapiro, whose clinic is launching one of three pilot programs coming to San Francisco. “So it makes a huge difference.”

Fighting meth with gift cards

Shapiro’s clinic focuses primarily on opioid addiction, but more than half of their patients also have a stimulant use disorder, he said.

While the deadly opioid fentanyl gets most of the attention in the drug epidemic in California and across the country, experts say stimulant use is a major — and growing — concern. In 2021, 65% of drug-related deaths in California involved cocaine, methamphetamine or other stimulants — up from 22% in 2011, according to the California Department of Health Care Services.  Nationally, there were 15,489 overdose deaths involving stimulants other than cocaine (largely methamphetamine) in 2019, up 180% from 2015, according to a study by the National Institute on Drug Abuse.

And with California in the midst of a dire homelessness crisis, stimulants are wreaking havoc on the state’s unhoused community. Among unhoused residents who use drugs, amphetamines are by far the most common choice, according to a recent study by the UCSF Benioff Homelessness and Housing Initiative. Nearly one-third of people surveyed reported using amphetamines three or more times a week, compared to just 11% who used opioids with the  same frequency. Some people who live on the street reported using stimulants to stay alert at night, when they fear being attacked if they fall asleep. 

To combat stimulant addiction among its patients, Zuckerberg San Francisco General Hospital recently launched a six-month contingency management program as part of the statewide pilot. The hospital opened enrollment on July 17, and staff hope ultimately to serve about 50 people. Clinicians will test participants for stimulants once or twice a week. Each time patients test negative, they’ll get a $10 gift card to Walmart or another retailer. The amount of the gift card gradually will increase, for a maximum of $26.50 per test. If they test positive, they get nothing. 

Participants can earn a maximum of $599 over the course of the program. That’s because payments of $600 or more must be reported to the Internal Revenue Service.

Santa Clara County hopes to launch a similar program within the next few weeks. So far this year, 70% of the 120 drug deaths recorded in the county involved methamphetamine, according to the Office of the Medical Examiner-Coroner. 

“We’re all excited to try it and see if it does help retain people in treatment for longer periods of time so they are more successful,” said Tammy Ramsey, program manager for the Drug Medi-Cal Organized Delivery System in the county’s behavioral health department. 

Contingency management works

Other programs in counties throughout California — including Alameda, Fresno, Nevada, Sacramento and Los Angeles — will follow the same model. 

If the trials are successful, Shapiro hopes the state will allow them to expand and serve everyone on Medi-Cal.

The model already has proven effective for the Department of Veterans Affairs, according to Dominick DePhilippis, the department’s deputy national mental health director for substance use disorders. The VA started using contingency management in 2011, and as of the beginning of July, the program has treated more than 6,300 veterans. Those veterans have attended about half of their appointments and produced nearly 82,000 urine samples – of which more than 92% were negative for the targeted drug, DePhilippis said.  

It’s not just the VA. Of 22 studies testing contingency management’s impact on stimulant addiction, 82% reported “significant increases” in participants’ abstinence, according to a 2021 meta-analysis published in JAMA Psychiatry.

Shapiro believes the model works because it replaces the reward a patient’s brain craves (the drug) with a different type of prize.

“It’s a little bit like winning something,” Shapiro said. “It triggers that reward place in the brain that otherwise they would be turning to the drug for.”

But Tom Wolf, who has battled addiction and homelessness himself and now advocates for drug policy reform, said he worries using Medi-Cal to fund contingency management will create bureaucratic hurdles to treatment as patients wait for the state to decide if they are eligible. Still, he said, the program is worth a shot.

“At this point I’m willing to try it, basically because we have such a dearth of options for people that are struggling with addictions in California,” he said.

Because of how difficult it is to treat his patients that use stimulants — many of them use methamphetamine every day — Shapiro would be happy if even a quarter of participants significantly reduced or stopped using. There is also concern, as with any type of treatment, that patients will relapse once the program is over, he said. To help prevent that, the hospital will provide six additional months of counseling after the contingency management program ends. 

It’s not a perfect solution

Rewarding people for staying sober doesn’t work for everyone. Even before it was covered by Medi-Cal, Zuckerberg San Francisco General Hospital was experimenting with the model in small programs.

One of the participants in those programs, 54-year-old J.W., ended up in the emergency room with heart failure after two decades of methamphetamine use. After his hospital stay, he enrolled in a 12-week program called Heart Plus, which caters to cardiac patients with a history of stimulant use. Every time J.W. did something positive, such as show up to an appointment, take his medication or get a negative drug test, he got to draw a Safeway gift card out of a hat. The cards’ value ranged from $5 to the “elusive” $20, and J.W. — who asked to go by his initials out of fear of being stigmatized for his drug use — estimates he earned about $180 throughout the entire program. He wasn’t working at the time, so the cards helped him get treats such as deli sandwiches and fancy bottles of kombucha. 

“It was definitely something to look forward to,” he said. “And it was something fun to spend.”

Click here to read the full article in CalMatters

Psychedelic Drug Decriminalization Bill Passes Senate Public Safety Committee

Another new Assembly Bill with narrower focus quickly gains support

A bill to decriminalize plant-based psychedelic drugs was passed by the Senate Public Safety Committee this week completing the bill’s first major hurdle, while a new major challenge to the bill has quickly gained support in the Assembly.

First introduced in December of last year, Senate Bill 58 by Senator Scott Weiner (D-San Francisco) would decriminalize plant-based and other natural hallucinogens such as psilocybin (magic mushrooms), dimethyltryptamine (psychedelic drug DMT), ibogaine (psychedelic substance), and mescaline (psychedelic hallucinogen). In addition, law enforcement would be unable to charge those holding the drugs with a criminal penalty while also still being completely illegal for minors.

SB 58 would also remove bans on having psilocybin or psilocyn spores that can produce mushrooms and on having drug paraphernalia associated with all decriminalized drugs.

The bill is a significantly pared down version of SB 519, first introduced in January 2021 by Weiner that would have not only legalized the psychedelics in SB 58, but also would have included synthetic hallucinogens such as lysergic acid diethylamide (LSD), ketamine (“dissociative anesthetic”), and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy, molly). However, the bill was amended heavily in 2021 and 2022, removing ketamine and other troubling parts for legislators and oppositions groups, such as law enforcement agencies. Despite the changes, the bill was still gutted in August, removing everything but a single study on the use of the remaining drugs. SB 58 continued to water down the bill, removing peyote from the proposed decriminalization list and removing a provision to study future reforms.

The effort to make the decriminalization more palatable for lawmakers appeared to be working on Tuesday, with the Senate Public Safety Committee voting 3-1 to pass the bill.

Before the vote on Tuesday, Senator Wiener noted that “These are not addictive drugs. And these are drugs that have significant potential in helping people to navigate and to become healthy who are experiencing mental health, challenges substance use challenges.”

“We know that cities in California and elsewhere have passed resolutions to categorize enforcement of these particular criminal laws as the lowest law enforcement priority. This is an important step for California. This is about making sure that people have access to substances that they need that are not addictive.”

Rival bill in Assembly expected to challenge SB 58

However, while SB 58 did ultimately move this week, another bill on the horizon in the Assembly is now threatening to derail it. Assembly Bill 941, authored by Assemblywoman Marie Waldron (R-Valley Center), was introduced last month. According to AB 941, certain psychedelic drugs would be green-lighted for use, but only in psychedelic-assisted therapy sessions for combat veterans.

The bill, also known as the End Veteran Suicide Act, takes a more cautious approach and would authorize a licensed professional clinical counselor to administer controlled substances to combat veterans. Psychedelic-assisted therapy would be required to take place over a minimum of 30 sessions, with therapy sessions to be a minimum of 12 hours in duration. The bill would also require 2 or 3 licensed professional clinical counselors  present per patient at a psychedelic-assisted therapy session.

While the bill is currently awaiting to be heard in the Assembly, many law enforcement and medical professionals noted that AB 941 is preferable to SB 58 due to more of a controlled and monitored use, as well as the serving as more of a test to see if psychedelic treatments could then be expanded to more Californians in a safe and effective manner.

“Wiener’s bill is more one size fits all,” explained former police officer and current drug counselor Marty Ribera to the Globe on Thursday. “This other bill is a bit more tailored. Psychedelic treatment isn’t for everyone. And rather than just decriminalize willy-nilly, AB 941 can help bring along a pathway to use them for good, and more critically, to identify the people who can benefit from their treatment and making sure that using them would not bring on any negative side effects like depression, long-term psychosis, or in more of a social context, bad trips.”

“We need this to be on a case by case basis and  to have a small pool to test on to make sure his type of therapy can work like this.  Psychedelics can help treat major issues like PTSD. We have the research. But we also see psychedelics ruin peoples lives. I’ve always said, for every success story there are two others that tried it on their own and ruined their life. We need to be open to this as a treatment, but also very cautious about it.”

Click here to read the full article in the California Globe

L.A. Riders Bail on Metro Trains Amid ‘Horror’ of Deadly Drug Overdoses, Crime

Matthew Morales boarded the Metro Red Line at MacArthur Park as classical music blared over the station loudspeakers.

It was rush hour on a Tuesday afternoon, and Morales made his way to a back corner seat and unfolded a tiny piece of foil with several blue shards of fentanyl. As the train started west, he heated the aluminum with a lighter and sucked in the smoke through a pipe fashioned from a ballpoint pen.

Doors opened and closed. A few passengers filed in and out. A grain of the opioid fell to the floor. He concentrated on trying to pick it up, then lost track, as his body went limp. His shoulders slumped and he slowly keeled forward.

By the time the train arrived at the Wilshire/Western station, Morales, 29, was doubled over and near motionless, his hand on the floor. The train operator walked out of the cabin, barely glancing at him as she passed — as if she encountered such scenes all the time.

Drug use is rampant in the Metro system. Since January, 22 people have died on Metro buses and trains, mostly from suspected overdoses — more people than all of 2022. Serious crimes — such as robbery, rape and aggravated assault — soared 24% last year compared with the previous.

“Horror.” That’s how one train operator recently described the scenes he sees daily. He declined to use his name because he was not authorized to talk to the media.

Earlier that day, as he drove the Red Line subway, he saw a man masturbating in his seat and several people whom he refers to as “sleepers,” people who get high and nod off on the train.

“We don’t even see any businesspeople anymore. We don’t see anybody going to Universal. It’s just people who have no other choice [than] to ride the system, homeless people and drug users.”

Commuters have abandoned large swaths of the Metro train system. Even before the pandemic, ridership in the region was never as high as other big-city rail systems. For January, ridership on the Gold Line was 30% of the pre-pandemic levels, and the Red Line was 56% of them. The new $2.1-billion Crenshaw Line that officials tout as a bright spot with little crime had fewer than 2,100 average weekday boardings that month.

Few stations compare with MacArthur Park/Westlake. The station sits next to an open-air drug market that’s existed in this dense immigrant neighborhood for decades. About 22,000 people board the trains here daily.

The Los Angeles County Metropolitan Transportation Authority reported that between November and January there were 26 medical emergencies at the station, the majority of them suspected drug overdoses. Last year, there were six deaths and one shooting, nearly all related to suspected drug activity. Earlier this year, a 28-year-old man was fatally stabbed in a breezeway of the station.

Maintenance crews are often called out for repairs at the station, and when they return to their vehiclethey often find it has been burglarized. Gangs control the area and police say many of the informal vendors on the sidewalks are part of the larger drug economy, wittingly or not. Some are forced to pay the gang taxes, others sell stolen property.

The transit agency’s head of security has said she will be asking the 13-member board — that includes Mayor Karen Bass and the county supervisors — to expand the agency’s force of nearly 200 in-house transit officers, some of whom are armed and enforce fare evasion and code of conduct violations. And the board will soon decide whether to continue contracts with the Los Angeles Police Department, the Los Angeles County Sheriff’s Department and the Long Beach Police Department, or come up with another way to secure the system.

Some board members and social justice advocates have argued for less policing on the system, saying that racial profiling targets many passengers.

“What will harassment and jailing people who use drugs do to address drug use rates?” said Alison Vu, a spokesperson for the Alliance for Community Transit-LA, a social justice advocacy coalition that wants the agency to eliminate contracts with law enforcement. “We’ve poured so much money into policing, without any measurable impact on care or safety for transit riders.”

In response to such concerns, transit officials committed $122 million over the last year trying to make the system — composed of 105 rail stations and more than 12,000 bus stops — feel safer by placing 300 unarmed “ambassadors” to report crimes and help passengers. It’s part of what officials like to tout as a “multilayered” approach to improving a system that’s become emptier and more dangerous over recent years — even as billions have been sunk into expansion of the rail lines.

“I do think there’s something about the culture of the riding public, that if they know there’s someone who is empowered to report [illegal activity] that may be a deterrent to the activity itself,” said Metro Chief Executive Stephanie Wiggins.

Wiggins touted the rollout of the ambassador program to the news media on March 6. Followed by a phalanx of ambassadors, she boarded a Gold Line train from downtown Union Station to Heritage Square in Montecito Heights to show how what she and others call the “eyes and ears” of the system will work.

As Wiggins talked to reporters, a man in the next car was packing marijuana into a cigar wrapper. The ambassadors didn’t discourage the man as he threw tobacco on the floor to make room for the weed.

Melissa Saenz, one of several newly minted ambassadors on the train, leaned over to tell a reporter that in instances such as this she would “report it” to law enforcement. “We are here to make a change.”

But even law enforcement said they can only do so much.

During the final three months of last year, LAPD arrested 49 people on the Red Line for drug-related offenses. As of mid-February, only one of those arrests resulted in a criminal filing, said LAPD Deputy Chief Donald Graham, who oversees the department’s Transit Bureau.

Many drug possession charges in California are misdemeanors or are considered lower-level offenses. And as such, the cases are often a low priority. Evidence often sits in a crime lab for months.

The Los Angeles County Department of Public Health reported deaths linked to fentanyl rose from 109 in 2016 to 1,504 in 2021, amounting to a 1,280% increase. First responders now often carry Narcan, an opiate reversal, and they need it on the Metro.

The deaths from fentanyl and fentanyl-laced methamphetamine occur across the system. There were nine confirmed overdoses at rail stations last year, all men. But those figures will probably rise as the coroner’s office closes more cases.

There was Oscar Velasquez, 23, who died at the downtown Santa Monica station; Trivonne Vonner, 35, found at the Firestone station in an unincorporated area of South Los Angeles; and Ervin Siles Gutierrez was pronounced dead at the Vermont and Santa Monica station in East Hollywood.

“There’s so many ‘sleepers,’ ” the train driver said. “Nobody notices that the guy quit breathing until they’re blue. And then by that time, it’s too late.”

Fentanyl is a syntheticopioid drug that is 50 times more potent than heroin and cheap. A single dose can be bought for about $5. But it’s extremely addictive, in part because of the withdrawal it provokes — jitters, diarrhea, extreme anxiousness andnausea.

“It’s like the worst flu you’ve ever had in your entire life. And it just gets worse over time,” said Susan Partovi, a doctor who treats users on skid row. “That has become most of the people’s main motivation — to continue opiate use is to avoid withdrawal symptoms.”

She said overdose prevention sites, where people who are addicted could ingest drugs safely and without shame, could prevent such public nuisances as people doing drugs in elevators or on trains.

Gov. Gavin Newsom vetoed legislation last year to begin a pilot program of these consumption sites in Los Angeles, San Francisco and Oakland. In his veto message, he said he was open to discussion on limited sites, but he said without a strong plan the legislation could have induced a “world of unintended consequences.”

The “sleepers” were at Union Station one recent weekday afternoon as a petite woman, who spoke little English, looked for the train to the Expo Line.

She walked into a train car that was empty but for three passed-out passengers. She looked at them and walked back out. Unsure what to do next, she stood looking confused on the platform. An ambassador came up to ask if she needed help.

“Expo,” she said.

She was on the right train, he said. But she shook her head, she didn’t want to return to the cars. So he walked her into another car and stayed with her. The doors closed.

People waited for hours to board the train when it opened in 1993.The MacArthur Park/Westlake station was the original Western terminus of Los Angeles’ first subway, with a plaza that looks out to the park.

On a recent Tuesday afternoon, used needles and human feces littered the station’s parking lot. Just around the corner near Alvarado Street, a man smoked from a glass pipe as a steady stream of people walked by.

Drug users and homeless people hang around the edges of the plaza and have breached locked areas in the station, creating a danger for riders and staff.

“It’s the most challenging [station] relative to drug use,” said Conan Cheung, Metro head of operations. “People are loitering there on the plaza and it is spilling into the ancillary areas, which makes it even more of an emergency.”

The smaller entrance is now closed off by fencing, as are large swaths inside the battered station.Transit officials recently beefed up security and the presence of ambassadors there. But they have also been trying to design away the problem by reducing the open floor space, pressure washing floors and piping in classical music to keep people from loitering. Metro is looking atreplacing the wide benches on the platform,regulating vendors and blocking off parts of the plaza.

Metro board member and Supervisor Hilda Solis asked the agency to consider another approach, and come up with a plan that will make the station and plaza more inviting to the community at large. She’s asked the agency to look at “care-centered strategies” including a vending program, health and crisis support services, cultural programming, public art, bathrooms and shade structures.

LAPD foot patrols were inside and outside the MacArthur Park/Westlake station when a Times reporter and photographer visited on a recent Tuesday.

“Most people come here to buy drugs and then they do them on the train,” said Jerry Settlemire, who emerged from the platform with his wife, Michelle.

But the changes barely registered with the couple.The two said they had recently been released from the county jail and came to cop “fetty,” as fentanyl is known on the streets.

After talking for a few moments, a jittery Michelle Settlemire began looking around.

“I’m ready to get high,” she said.

They walked away from the station to buy drugs.

Before Morales boarded the train to smoke his drugs, he was outside the station plaza in a brisk breeze as people whizzed by. Women held their children’s hands. Others talked on phones. Then there were those with drawn faces who looked as though they hadn’t slept in days. Many were thin and some, like Morales, had bloody marks on their faces or limbs. He didn’t sleep the day before but seemed happy to talk.

Click here to read the full article at LA Times

Senator Weiner Reintroduces Psychedelic Drug Decriminalization bill

SB 58 waters down previous versions of the bill by only keeping in plant-based psychedelic drugs

A bill to decriminalize plant-based psychedelic drugs was reintroduced on Monday in a much-watered down version that previous iterations have taken.

According to Senate Bill 58, by Senator Scott Weiner (D-San Francisco), plant-based and other natural hallucinogens such as  psilocybin (magic mushrooms), dimethyltryptamine (psychedelic drug DMT), ibogaine (psychedelic substance), and mescaline (psychedelic hallucinogen) would be decriminalized, with police being unable to charge those holding the drugs with a criminal penalty and the drug still being across the board illegal for minors.

The bill is a significantly pared down version of SB 519, first introduced in January 2021 by Weiner that would have not only legalized the psychedelics in SB 58, but also would have included synthetic hallucinogens such as lysergic acid diethylamide (LSD), ketamine (“dissociative anesthetic”), and 3,4-methylenedioxymethamphetamine (MDMA, ecstasy, molly). However, the bill was amended heavily in 2021 and 2022, removing ketamine and other troubling parts for legislators and oppositions groups, such as law enforcement agencies. Despite the changes, the bill was still gutted in August, removing everything but a single study on the use of the remaining drugs.

However, as promised, Weiner brought the bill back on Monday, stripping it of the more controversial synthetic drugs. Wiener also kept in tact the reasons behind the bill – to end the mass incarceration that occurred during the war on drugs, as well as to increase scientific and medical testing to help those suffering from mental health conditions such as PTSD and depression.

Weiner brings back psychedelic decriminalization bill

“Research from top medical universities shows that these substances can have significant benefits, particularly for treating mental health and substance use disorders, and decriminalizing their personal use is part of the larger movement to end the racist War on Drugs and its failed and destructive policies,” Wiener said in a press release on Monday. “In the past few years, the mental health and addiction crises have worsened. Since the onset of the pandemic, so many people have dealt with unemployment and financial distress, a lack of community and social isolation, and loss of friends or family — anxiety, depression, overdose and suicide rates are up across the country. With many people seeking treatment for these conditions, it’s critical that we look to alternatives to criminalizing and incarcerating people who are using psychedelics to heal.”

“For veterans, many of whom live with Post-Traumatic Stress Disorder (PTSD), access to psychedelics can be lifesaving. Veterans die by suicide at a rate of 1.5 times the general public. That’s why Veterans Affairs is studying psychedelic therapy, and why so many veterans are advocating for the decriminalization of psychedelics. Psychedelics have tremendous capacity to help people heal, but right now, using them is a criminal offense. These drugs literally save lives and are some of the most promising treatments we have for PTSD, anxiety, depression, and addiction.”

Despite Senator Wiener’s advocacy for the decriminalization of the plant-based hallucinogens, as several Californian cities have done, as well as Oregon and Colorado recently passing similar measures, there is still a large segment of opposition against SB 58. While law enforcement groups in large part, others, including medal professionals, also oppose the bill given the significant dangers involved.

“Wiener is trying to make it sound like nothing can go wrong with taking these drugs,” explained former police officer and current drug counselor Marty Ribera to the Globe on Monday. “But he is so wrong. What about the bad trips? What about depression caused by these drugs? What about long-term psychosis? For every success story there are at least 2 others that involve a ruined life. These drugs are illegal, and criminalized, for so many reasons.”

Click here to read the full article in the California Globe

Parent Says 10-Month-Old Barely Survived Ingesting Fentanyl at Popular SF Park

“It’s horrible. It makes me just reconsider staying in San Francisco and if we should move,” said parent Alexis St. George.

The San Francisco Police Department is investigating a medical emergency that sent a 10-month-old to the emergency room. The child’s parent says the baby ingested fentanyl.

San Francisco firefighters and paramedics were sent to a popular park in the Marina District.

San Francisco resident Michael Halpern witnessed the medical response.

“My office is right there. We saw paramedics and people and the stretchers going on. Then the mommies over there with the babies and the nannies and people in distress,” said Halpern.

The parent of the child posted on social media that their 10-month-old barely survived after ingesting fentanyl while playing at Moscone Park. On Wednesday, parents were on edge.

“It worries me that he is going to pick up something like that. Get it on his hands and then put it in his mouth. At this age you shouldn’t worry about your kid consuming something like fentanyl,” said parent Kirsten Chalfant.

In a new post, the parent said the nanny reacted quickly. After noticing the baby’s mouth turned blue and he began to have trouble breathing. According to the parent the baby was given Narcan an opioid overdose reversal drug.

The San Francisco Police Department confirmed they are investigating the cause of the medical emergency. The fire department said they couldn’t confirm the claim of the baby ingesting fentanyl at the park and added:

“We responded to Moscone Park for a pediatric patient in cardiac arrest. San Francisco Fire and Paramedics arrived on scene in 2 minutes, provided life-saving measures and revived the patient.”

San Francisco Supervisor Catherine Stefani represents the Marina District.

“I’m a mother myself and I would say just to be very cautious and to look around and to know that we are doing everything in District 2. We are responding with police presence and have rec and parks respond in the way they can,” said Supervisor Stefani.

Luz Pena: “What is your office going to do? What are you doing about this?”

Supervisor Stefani: “What I have been doing is making sure that we are not just engaging in harm reduction but that people have paths to recovery. The whole purpose of harm reduction is to make sure that the addict doesn’t get sick from a dirty needle. But if our focus on harm reduction is actually potentially harming others we need to reevaluate that.”

Supervisor Stefani said the San Francisco Recreation and Parks Department will close the park after hours, and police patrol will increase but for some parents, this incident may be their tipping point.

“It’s horrible. It makes me just reconsider staying in San Francisco and if we should move,” said parent Alexis St. George.

SFPD Statement:

“On 11/29/22 at approximately 10:16 p.m., San Francisco Police officers from Northern Station responded to a local hospital for a report of male infant that had undergone a medical emergency. Officers met with the witness who was with the child at Moscone Recreational Park at approximately 2:30 p.m., when the medical emergency occurred. The San Francisco Fire Department responded to the scene and transported the child to the hospital for a life-threatening emergency. The cause of the medical emergency is still under investigation.

Click here to read the full article at ABC 7 News