(a) The Human Services Agency (“HSA”) administers the City’s County Adult Assistance Programs (“CAAP”), consisting of General Assistance, Personal Assisted Employment Services Program, Cash Assistance Linked to Medi-Cal Program, and Supplemental Security Income Pending Program, which together provide financial assistance and social services to eligible indigent adults who have no other source of income or benefits.
(b) The incidence of substance use disorders among San Francisco’s CAAP population is higher than among the general population. According to HSA, from 2018 to 2020, approximately 20% of CAAP recipients self-disclosed in an initial interview with HSA staff that they have substance abuse issues. By comparison, the federal Substance Abuse and Mental Health Services Administration reported that, from 2005 to 2010, 10.8% of the San Francisco-Oakland-Fremont metropolitan statistical area had a substance use disorder. Based on publicly available information, the incidence of substance use disorder among CAAP recipients who are experiencing homelessness is concerning. Further, in 2022, the San Francisco Homeless Count and Survey released by the Department of Homelessness and Supportive Housing found that 52% of individuals experiencing homelessness reported their drug or alcohol use as a disabling health condition, representing a 10% increase from 2019. In its Accidental Drug Overdose Reports for 2020 through 2023, the Office of the Chief Medical Examiner has determined that at least 25% of drug overdose decedents have no fixed address.
(c) Among programs intended to support recovery from substance use disorders, medical literature widely supports contingency management strategies as effective treatments. In contingency management strategies, patients receive tangible incentives to reinforce positive behaviors such as abstinence from addictive substances or behaviors, or adherence to Medication-Assisted Treatment (“MAT”) where patients are prescribed medications, such as buprenorphine, methadone, and naltrexone, to treat opioid use disorders.
(d) The San Francisco Department of Public Health (“DPH”) currently offers contingency management programs, including programs authorized by the California Department of Health Care Services. DPH’s 2022 Overdose Prevention Plan proposed to increase the number of programs offering contingency management from three to five, and increase the number of people participating in contingency management programs by 25%.
(e) On March 5, 2024, the voters passed Proposition F, which, as of January 1, 2025, will require all adult CAAP recipients to undergo screening for substance abuse when HSA determines that there is reasonable suspicion to believe that an individual is dependent upon illegal drugs. If the screening indicates there is reason to believe the recipient is abusing or dependent on illegal drugs, Proposition F will require that recipient to undergo a professional evaluation for substance abuse to receive further CAAP benefits. If, as a result of the professional evaluation, a provider determines the recipient requires substance abuse treatment, the provider will refer the recipient to a treatment program.
(f) The purpose of the Pilot Program established in this Article XX is to incentivize both drug-free and medically-assisted recovery from substance use disorders for those individuals who, under Proposition F, must undergo substance abuse treatment, and to strengthen drug overdose prevention efforts using contingency management methods.
(Added by Ord. 257-24, File No. 240799, App. 11/14/2024, Eff. 12/15/2024)