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Mon, Dec

Drug User Health Hubs Are Coming to Skid Row…But Where is the Data?

LA DRUG CRISIS - A June 28, 2022 Motion by LA County Supervisor Hilda L. Solis outlines something called the “Skid Row Action Plan: Improving the Lives of Residents on Skid Row by Addressing Homelessness Stemming from Decades of Institutional Racism”.

This Motion calls for several new initiatives, including a “Substance Use Health Hub”. Language from the Motion reads:

Implementation of a Substance Use Health Hub space is critical to the well-being of the people who reside in Skid Row. This Hub should include access to low barrier Medications for Addiction Treatment (MAT), health services, substance use services with a full spectrum of resources, mental health services, respite/detox beds, and chill out spaces. An overdose prevention/safe consumption site could be added once new legislation, or a Skid Row overdose state of emergency is enacted. The Hub would also include space for 24/7 phone charging, showers, toilets, laundry, snacks, and activities related to reducing negative outcomes from substance use.

I applaud Supervisor Solis for this thoughtful Motion. Acknowledging the pervasiveness of drug use in Skid Row is one thing but taking a health opposed to carceral approach is a breath of fresh air.

Containment Policy & Housing First

Decades of failed crack downs have done absolutely nothing to solve the problem and instead made the lives of mostly Black constituents more precarious. After all, the “containment policy” is still in effect. Drugs are tolerated by law enforcement (for the most part), so long as they are contained within Skid Row’s boundaries. Also, the neighborhood’s low-income housing has a mandated “Housing First” policy. California State law dictates:

…all housing programs to adopt the Housing First model.1 The Legislation defined Housing First with these “core components”: • Tenant screening and selection practices promote accepting applicants regardless of their sobriety or use of substances, completion of treatment, or participation in services. [Emphasis added]

The community serves as both a place where people use drugs, and have some protections for doing so, as well as a place of recovery for people who seek to escape their addictions. This dichotomy can be difficult to wrap your head around and makes for unlikely alliances and tensions.

Skid Row is like a giant release valve for the region. The drugs are not going to be eliminated because of policies in place that dictate that they stay corralled here. So, what to do now that Fentanyl is on the scene and killing people, instead of just getting them high? The Solis Motion is inching towards a safe-consumption model. I think the Supervisors know that Skid Row would be the most appropriate place for such a facility, and yet, curiously, there does not seem to be any DATA that would support this.

The Meetings

Since the Solis Motion was passed, LA County has been holding participatory meetings in the community. In attendance have been County and City staff, NGO representatives and local residents. The feedback portion of the meetings just wrapped and final recommendations were submitted. Now the County will formulate a plan for how to roll out their initiatives.

I attended all the “Drug Hub” meetings and although they started out on a promising note, I am left feeling deeply conflicted and desiring of much more information. We were asked to give recommendations based on literally zero data. All NGOs and governmental initiatives operate on data - that is how money is allocated. How many fed, sheltered, housed, showered, serviced? You mean to tell me there are NO numbers on how many have died from overdoses in Skid Row, per month, year, week? Because that is what we were in the room to talk about. And by the way, how many reversals have there been in Skid Row per month, year, week? No one knew. Or, I should say, this information exists, but no one from the County or City wanted to go through the trouble to gather, organize then present this data to the community – the ones affected. I very specifically asked about OD data – how many ODs, deaths, reversals? Meeting participants were asked to sign-in on sheets of paper, thereby creating data for the County on how many participated – so, its not as if they are unaccustomed to collecting data in Skid Row…

To live here is to constantly (daily) see the Fire Department and/or Coroner show up to take people away in vans. This leads to a certain numbness and seeds suspicion on the part of residents who rarely get official answers about what is happening. The County has a history of denying neighborhood-specific data for Skid Row that further marginalizes and disrespects the community. This is on top of all that the City does and has done to deny the Skid Row neighborhood acknowledgment.

During the height of the COVID19 pandemic, the LA County Public Health Department had a Public-facing dashboard listing infection and mortality rates by neighborhood, yet Skid Row was not listed – even though neighboring Downtown communities were. This despite massive and fatal outbreaks in area shelters. Mortality rates for Skid Row continue to be suppressed. If we (the People) do not understand the scope of the problem, how can we best work towards solutions?

It’s not as if this type of information and acknowledgement has not been sought before, repeatedly.

The LA Fire Department has data on calls, the Coroner has data on deaths and the hospitals have their own data about people coming from Skid Row. All this information is siloed. None of this was every presented at the meetings. Skid Row is siloed to the hilt. Of course, this all has to do with funding and perverse incentives – none of this has to do with a healthy and vibrant community.

What I heard from residents is that there is also a need for on-demand treatment alternatives for folks that many stumble into a Drug Hub. These treatment beds seem to elude residents of Skid Row, who are often told to fill out paperwork and wait…and wait. The “health” aspect needs just as much consideration as the safe-usage aspect I kept hearing. Places in Skid Row that used to house and help people with recovery have disappeared, such as the Salvation Army site, none have replaced them. There are concerns recovery is not being given as much attention as it should – including access to cutting edge medication such as Ketamine and Psilocybin.

Culturally Appropriate Harm Reduction

The devastation the crack epidemic caused to Black and Brown communities lingered like a thick fog in the Drug Hub meetings. Now that the face of opioids crisis is White, the health-centered approach is being pushed, when that was never on the table with crack.  There is resentment and anger over that, understandably. There is also a concern that not enough people in the Harm Reduction space look like the people of the neighborhood. There is a huge disconnect and much work still needs to be done.

Would Data Lead to Criminalization?

It’s a fair point to consider what sorts of nefarious uses law enforcement might come up with if OD data about Skid Row gets published. I wish more time was available to explore this. County staff repeatedly mentioned that collecting data can be pointless in and of itself. Community-driven data was mentioned. San Francisco has a Publicly- facing dashboard called the Tenderloin Emergency Initiative that lists overdose reversals (by entity), ODs (by Street, Private Residence or Other Location) as well as accidental deaths. Personally, I think this is critical information to know about one’s community. After months of meetings, I still have no idea what the scope of our OD crisis is.

Emergency Declaration

A portion of the Solis Motion, reads:

“An overdose prevention/safe consumption site could be added once new legislation, or a Skid Row overdose state of emergency is enacted.” [Emphasis added]

Early in the meetings, there was talk about what a “Skid Row overdose state of emergency” would look like. Again, I asked about data, but none came. Talk of any such declaration petered out but I wonder what was it supposed to be based on? Anecdotal stories? Whose? Internal data held by City or County Departments but not shared with the community? It was never explained.

A Sept. 16, 2022 LA Times piece states:

Last year, the Los Angeles Fire Department responded to more than 900 calls involving overdoses in the skid row area alone, according to data provided by an aide to Councilmember Kevin de León, who represents the area. [Emphasis Added]

This is the only Skid Row-specific data I have ever seen re: ODs, but again, it was not shared during the meetings.

This past September, a Hollywood Hills High School student died by ingesting Fentanyl (RIP). Within two weeks of this tragic accident, LAUSD had an emergency plan in place. The action was swift and coordinated. What exactly would it take for such an emergency plan to be enacted for Skid Row if not 900 OD calls within 1 years’ time? Maybe this means NARCAN-equipped ambassadors on every corner or in every building? Maybe it means speeding up the Drug Hub(s) or activating mobile units asap? I am disappointed that this was all left-open-ended and that there was no sense of urgency or timeline presented about what area residents can only conclude is SOME type of emergency. 

 

(Katherine McNenny works in Los Angeles' garment industry as a Patternmaker and lives Downtown. She is co-founder of Industrial District Green, an organization that has planted over 400 trees in the area. Her focus is on issues that affect the Skid Row neighborhood and how to improve City urban forestry policy.)