SAN FRANCISCO (CN) — A bold decision to provide alcohol, marijuana and tobacco to homeless people quarantined in hotel rooms in San Francisco has sparked controversy, but several addiction treatment experts say it is not an outlandish strategy.
“The approach of bringing substances to the people who are at the highest risk of transmitting Covid seems to me a reasonable approach,” said Kelly Dunn, professor of psychiatry and behavioral sciences at Johns Hopkins University. “It’s grounded in previous science.”
The approach is not without precedent. A study on Canada’s managed alcohol program, in which regulated doses of alcohol were given to people with chronic alcohol dependency, found participants were able to retain housing, reported improved relationships and well-being, and had fewer emergency room visits and withdrawal seizures. Several European countries have also experimented with providing controlled amounts of heroin to people with addictions.
The city of San Francisco has defended the practice as an evidence-based harm reduction strategy, but not all community members agree. When Thomas Wolf, a formerly homeless recovering addict in San Francisco, heard the city was brining addictive substances to people in quarantine, he was appalled.
“You're supposed to be offering treatment,” Wolf wrote in a May 1 tweet. “This is enabling and is wrong on many levels.”
Wolf did not respond to a request for an interview, but he told KRONTV on Wednesday that he thinks the city is blurring the line between reducing harm and enabling.
According to the city, private donations rather than city tax revenue is being used to deliver “medically appropriate amounts of alcohol” and cigarettes with meals to a few dozen people in quarantine. The goal is to deter them from breaking quarantine and wandering outside, which could increase the risk of spreading the novel coronavirus, Covid-19. The city said it also arranged for deliveries of medical cannabis to five people who paid for the marijuana themselves.
The city says those entering isolation are screened multiple times to determine what substances they would be uncomfortable living without, and they are offered support to reduce or stop using addictive substances.
“These practices, which are not unique to San Francisco, help guests successfully complete isolation and quarantine and have significant individual and public health benefits in the Covid-19 pandemic,” San Francisco Public Health spokeswoman Jenna Lane said in an emailed statement Thursday.
Because alcohol withdrawal can be fatal, some experts believe it makes sense to provide a controlled amount when treatment options are limited and the need to deter people from breaking quarantine is paramount in the interest of public health.
“There are more serious symptoms that some people can experience if they are particularly heavy drinkers — hallucinations and serious seizures that can lead to disability or death,” said Sarah Dermody, a psychology professor at Oregon State University who has done extensive research on addiction treatment.
When faced with an emergency situation, public health officials sometimes have to engage in a delicate balancing act weighing the risks to an individual’s health against the greater risks to public health.
“I agree that that means we would do things now that might not be the most ideal for an individual patient but might be protecting society from greater exposure to the virus,” said Andrew Saxon, psychology professor at the University of Washington who also directs addiction treatment research for the Veterans Affairs Puget Sound Health Care System in Seattle.
Under normal circumstances, Saxon says people withdrawing from alcohol would be encouraged to go to a hospital where they could be supervised by medical staff. However, with health care providers now focused on treating Covid-19 patients, that option may not feasible.
Any program in which addictive substances are provided to people carries the potential for abuse, Saxon says. The amount of alcohol provided depends on how much someone says they drink each day.
“They might say I drink a 6-pack a day,” Saxon said. “The person might think, ‘Why not get some extra alcohol? I could even give that to my friends and sell it so I’ll tell them to bring me two 6-packs.’”
Noting that nicotine and cannabis withdrawal symptoms are far less severe than alcohol withdrawal, Saxon also questioned the necessity of providing those substances to people in quarantine.
When it comes to tobacco, Saxon said public health officials could provide alternatives such as nicotine patches, gum or lozenges.
“That certainly gives people a better message than, ‘I’m going to give you the thing you’re addicted to,’” Saxon said.
Dr. Timothy Fong, a professor of psychiatry at the University of California, Los Angeles, thinks San Francisco’s novel approach could be beneficial so long as it’s done in a thoughtful manner. He said the program should be assessed to determine if it accomplishes the goals of keeping people in quarantine and reducing the need for emergency medical care. Fong recommends those in isolation should be tested, tracked and their contacts with others should be traced over time.
“If it turns out in two weeks that people were able to not go outside and not go to hospitals with withdrawal, that would be good,” Fong said.
San Francisco did not immediately respond to an inquiry on whether it is measuring the success of its program in keeping people isolated in hotel rooms.
Aside from alcohol, cigarettes and marijuana, the city is also delivering methadone, a federally regulated drug for treating opioid addiction, to quarantined people who are enrolled in a federally regulated program to receive that treatment.
On March 16, the federal government relaxed strict rules that require some patients to show up to clinics daily to receive methadone. Under the emergency rules, more patients are eligible to receive 14-day and 28-day supplies of methadone.
Dermody, of Oregon State University, applauded the federal government’s decision to expand access to larger supplies of the treatment so more patients can avoid wandering outside to get medication and risk spreading the virus.
“Given the circumstances it’s really important to ensure people have access to the treatment they need even if they can’t go to a place daily to get that medication,” Dermody said. “It seems like an important way to ensure the health and safety of individuals who need this treatment.”
During a press conference Wednesday, San Francisco Public Health director Dr. Grant Colfax defended the city’s decision to provide addictive substances to people in quarantine. He said “meeting people where they are” is the best approach to keeping the community safe.
“In cases where people decide that they are going to continue to use, our focus is using the best evidence to help people manage their addictions, and in some cases this will include helping them manage their alcohol use and their nicotine use so that they can stay safe and in place as much as possible to help their community and to help themselves,” Colfax said.
San Francisco is not the only city providing addictive substances to people in quarantine. A quarantine center in the Seattle suburb of Shoreline, Washington, also doled out beer and cigarettes to patients in an effort to keep them from roaming outside the facility.
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