Officials in San José, California are proposing a new solution to rising rates of methamphetamine use in Santa Clara County. Beginning March 4, people using methamphetamine in public will be offered a choice by law enforcement: receive a citation or be taken to an alcohol “sobering center.”
Sobering centers “provide a safe, supportive environment for mostly uninsured, homeless or marginally housed publicly intoxicated individuals to become sober,” states the American College of Emergency Physicians. People who enter these clinics may be given a bed, a shower or other care under the supervision of a nurse or paramedic.
In theory, sobering centers are intended to divert people under the influence from being admitted to a hospital or jail. Participants stay only for brief spells, and when the effects of alcohol wear off they are referred to outside programs like detox or rehab.
Santa Clara County health officials will soon begin the 12-month, million-dollar pilot program to bring people on meth to their Mission Street Sobering Center. Ten of the clinic’s 20 beds will be reserved for people arrested on meth violations who are nonviolent and have not been charged with a felony. Patients must consent to use the clinic; once admitted they will be given 24 hours to become sober before they are referred out.
Santa Clara County has seen a recent increase in meth use. According to health department data on people referred to substance use treatment, 38 percent of people indicated meth as their primary drug of choice, more than for any other substance. Police data showed that 60 percent of drug-related arrests and citations between October and December 2019 were for meth.
Using an alcohol sobering center for methamphetamine is uncommon, but not without precedent. One Portland, Oregon sobering center, orginally opened in 1977, adopted the policy being considered by Santa Clara and saw mostly meth users among its 3,700 annual patients in 2019.
But on December 23, it stopped taking meth-using patients, claiming it was too poorly resourced to meet their needs. The center’s leadership argued that the city instead needs to invest in crisis stabilization centers equipped to respond to the complex, long-term health needs of this population.
“Methamphetamine use contributes to a lot of behavioral crises that can be very dramatic and very severe,” said Amanda Risser, the Portland center’s director. “And that really threatens the health and wellbeing of the patient that’s experiencing it. And that can also lead to unsafety and risk in the setting.” The Portland center will in fact be closing completely in June, and the city is hoping to renew the existing contract with another provider.
Meanwhile, San José’s neighbor, San Francisco, will open an outdoor sobering clinic in its Tenderloin District later this year. It will be reserved exclusively for people using methamphetamine and is believed to be the first of its kind in the US. The clinic will use large tents with 15 beds each, staffed by nurses and counselors.
But how helpful are sobering centers for people who use drugs problematically? Evidence is lacking. “There are about 20 sobering centers across this country and dozens more looking to initiate sobering programs, yet there has been no research on sobering programs’ safety or cost efficiency until now,” states the University of California, San Francisco (UCSF).
UCSF nursing researcher Shannon Smith-Bernardin found that her city’s sobering center saved its healthcare system $3.5 million by relieving overburdened emergency departments. She and a team of researchers studied 11 sobering centers throughout the US to see how effective they can be both in patient outcomes and in saving money.
Her team found there isn’t enough data on patient outcomes, however. They also found that sobering centers don’t all follow standardized guidelines or protocols: One listed substance use treatment protocols written by the federal agency SAMSHA, while another listed protocols written by a state agency.
Transportation to sobering centers may be by ambulance, law enforcement or by a special van used by the clinic. Though there are many factors that may impact patient experiences, Smith-Bernardin’s team found that motivational interviewing, a housing-first approach, peer support and harm reduction practices all contributed to the best outcomes.
Taking people under the influence of meth to a medical clinic is certainly a better option than jail. But what is most critical is what happens after patients leave the clinic, and whether health officials can help connect people to longer-term solutions.
Photo by Gilberto Olimpio on Unsplash.