“We have to take care of people in a different manner,” Lurie said, “and it’s not by allowing them to continue to use and die on our streets.” A “different manner” actually means a crackdown. It means street distribution of foil, pipes and plastic straws is no longer allowed, with programs that offered harm reduction supplies from tables on sidewalks ordered to move indoors. It means more destruction of tent encampments, more police harassment and ticketing of people sitting or laying on sidewalks. 

The controversial Reset Center, described as a “law enforcement-led crisis stabilization center,” was opened in May. Police bring people they deem to be under the influence of drugs to be held in the locked facility for 24 hours.

This is the climate in which the Harm Reduction Therapy Center (HRTC) now operates. Founded in 2000, HRTC offers free counseling, operates a drop-in center and distributes safer-use kits to people who use drugs.

“We are not moving that person in a direction that somebody else thinks is important.”

They also have a van that parks in several neighborhoods and operates as a mobile pop-up, drop-in center. Their harm reduction therapy comes with hospitality: comfortable seating, canopies, coffee, snacks or a hot meal. It’s truly “meeting people where they’re at.”

HRTC’s Maurice Byrd and Anna Berg are all too familiar with the current backlash against harm reduction in San Francisco. Byrd is a licensed marriage and family therapist, and the center’s clinical training director. Berg is a licensed clinical social worker, and the clinical program director. Both have decades of experience working with people around drug use and mental health diagnoses.

Filter asked Byrd and Berg for their thoughts about the changes under Mayor Lurie, the human impacts of the rejection of evidence-based harm reduction services, and how this reflects an era of rising authoritarianism. Our interview has been edited for length and clarity.  

Helen Redmond: What is your response to the critics of harm reduction who say it enables people to use drugs and keep on using?

Maurice Byrd: Harm reduction enables people to stay alive. It enables a person to be healthy and as safe as possible. Ultimately, we’re not invested in people continuing their drug use if that’s what they choose and we’re not invested in people pursuing abstinence unless that’s what they choose. And I think that is what is difficult for people to really understand and that’s what is controversial. As harm reductionists, we don’t come in with a goal in mind for someone. So we’re truly in a collaboration with our clients to create those goals.

Anna Berg: When you say you’re enabling, it brings up an assumption that there’s something that somebody wants the person to do—that we are not forcing them to do. And so we are not moving that person in a direction that somebody else thinks is important. 

MB: I have a quick story. We were working at a shelter-in-place site, and a staff person who is now under scrutiny from the law called me into the office and asked, “Are you going to give our clients drugs?” That was her question! 

I said, “Wouldn’t that be illegal for me to give your clients drugs?” And I said no, I would not. Then she asked, “Well, you’re going to make sure they have drugs?” And I was like, “I’m not in the business of drug dealing. I’m a therapist.”

AB: We also want to help people think about what their options are. And sometimes folks get into spaces where it’s hard to know what the options are, they forget, get in a pattern, or in a survival place where all somebody can think about is what’s the next few moments. It’s part of our job as harm reduction therapists to help people explore and consider their options. And that’s the thing we enable people to do.

HRTC staff with the center’s van

HR: In a recent article by German Lopez in the New York Times, he wrote, “People struggling with addiction often need an outside push—from a family member, a friend or ultimately the government—to seek help.” Lopez argued the majority of people he’s interviewed said they needed threats and pressure to stop using drugs. What is your response? 

MB: We’ll just call that for what it is: cherry-picking. That’s a cherry-picking story. Do you know the number one way that people recover? It’s on their own without any intervention, something we call “aging out.” It’s not harm reduction, it’s not AA. It’s actually just spontaneous. 

I spent a fair amount of time in forensics working with people in custody in the San Francisco County Jail and San Quentin State Prison. I don’t want to completely say that coercive treatment, even though I disagree with it greatly, hasn’t been a starting point for some people. There could be an intervention that helps people jump off and do something different. It could be a starting point for some, but overall, that’s absolutely not how people recover.

AB: Change is hard, even if it’s something you really, really want to do, even if it’s something people in your life really want you to do. You have to have a sense of possibility, hope, and empowerment to take on change. Coercion and carceral treatment takes all the empowerment out and just forces and traumatizes folks. It undermines the whole change process. It causes harm and then what a lot of folks are doing to cope with harm is maybe the thing that brought them in contact with law enforcement in the first place. There’s something very misguided about what people think substance use treatment should look like. It can be authoritarian and paternalistic. 

HR: Critics of harm reduction are saying the focus is too much on drug-user rights and not enough on the impacts of drug use on families and communities. 

MB: We hear this mostly from politicians. This is a political question, because politicians could do something about it. You can make more drop-in centers. You could, God forbid, make safe consumption sites so people are not using outside on the streets. Oh my God, why not house people so that they have their own safe consumption sites, which is for most people their home?

Other countries have decided that they don’t want any neighborhood to be open drug zones, like Switzerland. So they invest in those neighborhoods in ways that reduce it. They decriminalize or legalize substances.

The politicians want to lay it at our feet because we treat people who use drugs with dignity and respect in a way that other people do not. We do it in a public way. I think that’s hard whenever people see that we’re treating people with respect, and they’re like, This person doesn’t deserve respect.

This is not a problem of harm reduction and this is not a treatment question. There is a scapegoat that needs to be created.

AB: You could actually make quality, engaging, compassionate treatment that people would be excited to go to because the whole person is attended to, not just one aspect of their life. 

Harm reductionists are looking at harm and impact and we’re looking at it on multiple levels. If there is harm to communities, families or to individuals, that needs to be part of the conversation. And that absolutely is part of the conversation in San Francisco. We’re in the business of trying to be part of the solution and invite folks into a thoughtful conversation of what their needs are. 

“They’re looking for people who fit a particular demographic. The other troubling part about the Reset Center: You’re not being arrested or detained—in my opinion, that’s being kidnapped.”

HR: Talk about the newly opened Reset Center in San Francisco. 

MB: It’s authoritarian. Who do you pick up off the streets? Unconscious bias exists, racism, and most of them are going to look like Black and Brown people. They are the ones who are going to get snatched off the street. Most of them are going to look like “people who use drugs”and people who are experiencing homelessness.

If they’re looking to take people off the streets who are inebriated, go to the Marina District. Go to the Marina every night. Go to the Castro every night. Go to these neighborhoods. [Instead] they’re looking for people who fit a particular demographic. There is the other troubling part about the Reset Center: You’re not being arrested or detained—in my opinion, that’s being kidnapped—and you can’t leave until you are cleared by someone. 

AB: We don’t want people to be outside using substances and struggling. Let’s invite people inside. Let’s do that. It will cost less. It will get less pushback. If we do that, we won’t have court cases—because we’re bordering on some legality issues with the Reset Center.

HR: What does the drug treatment landscape look like in San Francisco? 

MB: Since the ‘80s, we don’t have community mental health centers in the sense that we used to have them. Why don’t we take some of the money out of waging the drug war and invest that in actual treatment? 

This idea of a “War on Drugs” is obnoxious because you can’t get into a war with drugs, it has to be people. We’re in the middle of prohibition right now that’s killing people because we’ve decided to let drug dealers figure out the quality of the fentanyl that is being used, not the government. So this is a prohibition issue, it’s a race and class issue, too. 

There’s a big push with the Reset Center, they want people to go into treatment. Where are they going to go? There isn’t enough treatment available.  

We need treatment on demand, low-threshold—the lowest threshold possible. Wouldn’t that be phenomenal, if somebody walked up to a place and said, “I’m ready for residential treatment” and they walked right through the door?

AB: How do we do it that any door is the right door for somebody to come into treatment? As a service provider, I’ve experienced the barriers to treatment. There’s a phone number to call to get somebody into residential treatment or for intensive case management services. Every time I call, I’m asked, does that person have all their medications with them, any suicidal thoughts in the last 90 days, do they have insurance, an ID? Even when I have that person, there’s a wait.

“We need housing that is nice, not shitty, that doesn’t take all your money and you have rats for roommates.”

HR: Mayor Lurie and the San Francisco Board of Supervisors have rejected harm reduction and said it’s been tried and it’s failed. Where is that coming from?

AB: We’ve never fully implemented the principles of harm reduction into our drug treatment system, in our care system or in our health care system. We can’t say that it hasn’t worked, because we actually have not fully implemented or adequately funded programs. And it’s the same for Housing First. People say that they have a Housing First model and folks adopted some of the spirit of it, but a true Housing First model is really beefed up on services, has a really high touch point, and offers an array of supported services.

We need housing that is nice, not shitty, that doesn’t take all your money and you have rats for roommates.

The facts don’t matter. Politics and emotion dictate public health policy now. We’re in an era of rising authoritarianism, and only folks with money matter. We’re in this space where certain people’s opinions are more important than others. It’s leading us into a big mess.

MB: We never fully realized the dream of harm reduction. Since 2000 every contract for social services [in San Francisco] had to have a harm reduction philosophy. I call it a philosophy, because it’s not actual policy. It’s what we call “diet harm reduction,” or harm reduction-light—which means that it was written in your contract, more than anything else.

The problem with authoritarianism is that you don’t listen to people. You don’t listen to people like Anna or myself or Jeannie Little or Patt Denning, who have been doing harm reduction based work in San Francisco with people experiencing homelessness and using substances and mental health issues for 30 years. 

We’re really right on the verge in San Francisco of violating human rights. We’re like, right there. We’re taking freedom away from people.

Photographs by Helen Redmond

The post “It’s Authoritarian”—Harm Reduction Under San Francisco’s Backlash appeared first on Filter.

Under the proposed legislation, children would need to consent to be admitted, but of course this does not account for those who will be coerced into giving consent by their parents.

Therapeutic communities—private, usually faith-based residential drug treatment facilities where patients are subjected to forced labor and other abuses—are a historical feature in Brazil. But in recent years, political investment has created a massive, parallel care network that operates largely outside the official public health system. In 2025, the Federal Prosecution Office published a damning report on the human rights violations in these institutions, based on an investigation of 43 therapeutic communities across 25 states. It described facilities in remote locations where patients were physically and pharmacologically restrained, and prevented from contacting the outside world.

Though they are nonprofits, therapeutic communities receive substantial support from government contracts. Between 2017 and 2020, federal and local governments in Brazil spent more than $100 million USD on these shadowy, weakly regulated facilities.

In 2019, the first year of former president Jair Bolsonaro’s only term, the right-wing administration brought back involuntary commitment. In 2020, a resolution expanded that to minors between ages 12 and 18. That year the United Nations International Narcotics Control Board, noting that almost all of Brazil’s therapeutic communities use unscientific approaches, called upon “the Government of Brazil to implement voluntary, evidence-based treatment services with due respect for patients’ human rights,” in line with international standards.

The model built under right-wing Bolsonaro has largely persisted under left-wing Lula da Silva.

In 2021, a federal judge suspended the resolution that had expended involuntary commitment to minors. Seven former health ministers who had served under Bolsonaro and former presidents Dilma Rousseff and Luiz Inácio Lula da Silva (who was reelected as president in 2023) then signed an open letter calling for an end to the involuntary commitment of adolescents in therapeutic communities.

The letter argued that these institutions were not appropriate for children, and echoed broader concerns about human rights violations, family separation and the diversion of public resources away from the public health system. The ministers also called for releasing the hundreds of minors being treated in therapeutic communities, and suspension of federal funding for the placement of more minors in these settings.

The model built under right-wing Bolsonaro has largely persisted under left-wing Lula da Silva. Shortly after beginning his third term in 2023, Lula created a Therapeutic Community Support Department, against the advice of his health minister at the time. This move was criticized by the National Health Council and civil society organizations. Amid calls to invest in the country’s public health care system rather than faith-based institutions, the administration made the symbolic gesture of changing the name to the Department of Entities of Support and Welcoming Acting in Alcohol and Drugs.

In 2024, the National Council on Drug Policy (CONAD) approved a resolution revoking the Bolsonaro-era authorization of involuntary commitment of minors. However, for months the Ministry of Justice delayed it from taking legal effect. During the same period, the National Council for the Rights of Children and Adolescents (CONANDA) approved and promptly published a similar resolution. The episode exposed division within the administration.

Even as the government found ongoing abuses within the therapeutic community sector, the funding always continued.

While the Ministry of Health supported shifting away from the therapeutic communities, the Ministry of Social Development maintained close ties and continued funding them. Rather than dismantling the policies of Bolsonaro, as many voters had hoped, Lula’s government appeared caught between conflicting priorities.

In late 2024, researchers from the Federal University of Minas Gerais released the results of an oversight program—commissioned by the Ministry of Social Development—covering the 500-plus therapeutic communities receiving federal funding at that time. Its descriptions of overcrowding, restrictions on family contact and other harsh practices reinforced a recurring theme: Even as the government found ongoing abuses within the therapeutic community sector, the funding always continued. 

That contradiction has become a defining feature of Brazilian drug policy. Public defenders, health councils, children’s rights groups and even federal prosecutors have repeatedly questioned the use of therapeutic communities, but each new administration continues to finance them.

Over the past several years, the National Health Council, National Human Rights Council, National Social Assistance Council, CONANDA and, eventually, CONAD, have all approved measures opposing therapeutic communities or the institutionalization of minors. Yet new federal contracts continue to be awarded, and Lula’s administration is now facilitating the likely reinstatement of adolescent treatment. Criticism has accumulated much faster than policy change.

Image of Luiz Inácio Lula da Silva in 2023 via Ricardo Stuckert PR/Palácio do Planalto/Flickr/Creative Commons 2.0

The post Brazil’s Notorious Drug Rehabs Poised to Treat Children as Young as 12 appeared first on Filter.

Comment is due July 5. HHS appears to only be accepting submissions by email.

“HHS invites public comment in response to this RFI on the research, development, programs, and policies that have been most successful in improving availability of and access to effective prevention, treatment, and recovery interventions for addiction, mental illness, and co-occurring substance use and mental disorders,” the RFI states. “The purpose of this RFI is to identify research, programs, and policies that have been successful and recommend novel policy ideas and gaps in research that could be addressed and implemented to further the Great American Recovery using existing funding.”

President Donald Trump launched the Great American Recovery Initiative, which promotes the brain disease model of addiction, in January via executive order. It dovetails with the other executive order that HHS cites as the basis for its new RFI, which in 2025 escalated the use of civil commitment targeting unhoused people who use drugs.

In the wake of the 2025 executive order, the Substance Abuse and Mental Health Services rejected harm reduction, cutting grant support for what the RFI describes as “counterproductive harm reduction efforts that facilitate illegal drug use and its deadly consequences.” It reiterates that “safe use efforts and the provision of materials and drug paraphernalia, like syringes for illegal drug use, are not allowed with SAMHSA funding.” That ban is well established and isn’t going away anytime soon, but sterile syringe access would fit squarely within one of the SAMHSA funding streams highlighted in the RFI—the Hep C Free initiative designed to mitigate transmission and harms of hepatitis C.

Also highlighted is RFK Jr.’s STREETS Initiative, which will disappear unhoused people into coercive treatment programs.

Along with ending support for harm reduction, the agency’s guidance includes “development of non-opioid options” for pain relief. Two HHS departments—the Food and Drug Administration and the National Institute on Drug Abuse—recently advanced research exploring kratom as a treatment for opioid use disorder. The FDA considers kratom an opioid, but the move still serves the Trump administration’s interest in opioid alternatives, especially following the recent push to reschedule medical marijuana and fast-track psychedelic therapy development. It benefits pain patients, and people who use opioids, for more substances like kratom, marijuana or ibogaine to become regulated and accessible; it does not benefit them for prescription opioids to become less accessible as a result.

Among the funding opportunities highlighted are RFK Jr.’s STREETS Initiative, which will target people who are street-homeless and disappear them into coercive treatment programs. Such as SAMHSA’s assisted outpatient treatment, which is also one of the funding resources described in the RFI.

“An example of comments we are looking for: In the first Trump Administration, HHS helped coordinate take back days which took millions of pills out of homes and helped make the opioid overdose reversal medication naloxone more widely available,” the RFI states. “While these were significant policy wins, HHS can better coordinate with other agencies to achieve the President’s goals by ensuring there is alignment in goals to address addiction.”

It’s a bit bleak that HHS went looking to cite one of its significant policy wins and this was the example it came up with. Tons of policy-level changes have helped make naloxone more widely available over the past few years—over-the-counter products; the arrival of cheaper generics; harm reduction groups getting their own affordable naloxone supply; corrections departments increasing Narcan access for staff, and every once in a while for people in custody; a shelf-life extension; legislation mandating Narcan kits in schools and other public spaces; support for naloxone boxes and vending machines. But what the RFI is referring to is DEA agents handing out Narcan kits at biannual Prescription Drug Take Back Day events, for which various HHS departments contribute misleading promotional materials.

Image via the White House

The post HHS Wants Input on Which Kinds of Treatment and Recovery to Fund appeared first on Filter.

Convictions could be penalized with up to six months in jail and a fine of up to $500. The bill originally proposed incarceration for up to two years on subsequent convictions, but this was removed during the Senate committee review.

Modeled after coercive drug courts, the Homelessness Court Program purports to offer eligible defendants the so-called choice of treatment plus 12 months of probation as an alternative to incarceration—and charge them for the costs of their participation. If they can’t pay, a judge could waive the costs; attempt to assign them to a publicly funded treatment program; or force them into unpaid labor to work off the debt.

“‘Streets to Success?’” Jesse Rabinowitz, Campaign and Communications Director at the National Homelessness Law Center, told Filter. “That’s not success, that’s Jim Crow … they’re not really interested in getting people help, they’re using the unhoused to build more camps, to normalize forced labor. [That’s] authoritarianism.” 

Rabinowitz likened the bill to forced prison labor, which remains legal in Louisiana.

If a participant “fails” treatment, a judge could extend their probation even longer, or impose a new sentence, or send them into the state’s “intensive incarceration” for six months—after which they return to the Homelessness Court Program.

“I have no idea where they would get the money,” Rabinowitz said. “It’s so out of touch when more and more people are struggling to afford housing.”

“Cicero has been lobbying states all over the country.”

“Streets to Success” is being promoted by the Cicero Institute, the right-wing think tank behind the proliferation of public camping bans and other anti-homelessness legislation across the United States.

“Cicero has been lobbying states all over the country,” Rabinowitz said. “And you have right-wing governors trying to appease the Trump administration … it’s all connected. They’re not interested in addressing things. Not in making housing affordable. They’re making more people homeless that they then want to force into detention camps.” 

In 2025, President Donald Trump signed an executive order, “Ending Crime and Disorder on America’s Streets,” which pressed for the forced institutionalization of unhoused people. The order explicitly rejected the evidence-based “Housing First” approach, which recognizes the ineffectiveness of requiring preconditions like abstinence or employment. Rabinowitz pointed out that we do need more behavioral health care services across the country, but that local governments are following the Trump administration’s lead by defunding them.

“Trump is hell-bent on making it worse,” Rabinowitz said. “We need to fight for a country where everybody, regardless of where they’re from, what they do, what they look like, who they love—they’ve got a safe place to call home.”

The bill is currently with the Legislative Bureau. Melanie Bray, director of legal programs and advocacy for Disability Rights Louisiana, is fairly certain it will pass; the state has a long history of warehousing its most vulnerable residents. Bray recalled that in 2025 when New Orleans hosted the Super Bowl, unhoused people were “rounded up like cattle” and temporarily sequestered in a warehouse. 

“What gets lost is the human component,” Bray told Filter. “The loud part is, ‘This is a problem for business, it’s about fentanyl addiction, crime, property prices.’ What’s pushed aside is the human component—the people sleeping in the street.”

During the committee hearing, bill sponsor Rep. Debbie Villio (R) claimed that “external pressure”  offers unhoused people the option to break the cycle of criminalization.

“Quite frankly, I believe and others believe that it’s cruel to allow these people to not provide them the tools to help themselves,” Villio said, according to Nola.com. “And we’re dealing with the population sometimes that doesn’t want the tools.”

Image (cropped) via Washington State House Republicans

The post Louisiana “Homelessness Court” Would Offer Treatment, Forced Labor appeared first on Filter.

A March study published in The Lancet Regional Health — Americas highlights one particular strategy that could dramatically improve hep C treatment access for people who use opioids. The randomized controlled trial found that when people enrolled in opioid treatment programs (OTP) were offered hep C treatment on-site at those same programs, they were nearly four times more likely to initiate it compared to people who were given off-site referrals. 

Though the likelihood of patients completing the regimen and confirming they’d been cured was similar, the higher uptake in the OTP route would mean more people getting cured. The study is the first randomized controlled trial in North America to compare the two methods.

“[W]e’re able to show that integrating hepatitis C testing and treatments into OTPs transforms the hepatitis C care cascade,” lead author Dr. Oluwaseun Falade-Nwulia, an associate professor at the Johns Hopkins School of Medicine, told Filter.

Falade-Nwulia said this involved first training OTP providers to deliver hep C care to their patients. Next, finding people with lived experience to offer peer support through the treatment process.

Among patients offered on-site hep C treatment at OTP—commonly known as methadone clinics—nearly nine out of 10 initiated it. Only two out of 10 initiated care treatment through an offsite referral. After nine months, 61 percent of participants in the on-site treatment group had been cured of hepatitis C, compared to just 14 percent in the referral group.

Hepatitis C treatment does not require abstinence from substance use.

A decade ago, hep C treatment was revolutionized with the arrival of direct-acting antiviral (DAA) medications, which replaced interferon-based therapy. Interferon injections had to be administered every few days for the better part of a year, came with severe side effects and ultimately had a low success rate. DAA are oral medications, often taken for just eight weeks, that almost never cause any side effects and have a 95-percent success rate. And, critically, DAA do not require abstinence from substance use, which was a barrier with interferon.

Falade-Nwulia lamented that hep C is “still such a major public health issue,” when strategies like on-site treatment at OTP could have such a big impact. But what may seem like a straightforward intervention becomes complicated by the health care industry.

Hep C treatment is extraordinarily expensive, and so patients must first be enrolled in insurance that will cover it. In many states, patients must obtain prior authorization from Medicaid before they can receive DAA—a process that can delay care or discourage providers from offering it altogether. Seventeen states currently impose some form of prior authorization requirement. So hep C continues to spread among those least able to access treatment.

“The way OTP reimbursement is structured currently in the US limits the ability of the OTP to get additional compensation for providing this additional service,” Falade-Nwulia said. “I think we really do need policy change to provide additional support to OTPs to be able to integrate this care in their settings.”

“This is just such a low-barrier, low-threshold approach.”

One clear advantage of the OTP strategy is that it leverages existing infrastructure, upskilling staff and peers to support patients more effectively. It is not a complex or high-tech intervention, and it may be one of the most effective.

“This is just such a low-barrier, low-threshold approach,” Falade-Nwulia said. “I think the additional cost at the system level is significantly outweighed by the potential benefit, both to the people accessing services at these OTPs and the larger society that will be protected from ongoing transmission of hepatitis C.”

Still, Falade-Nwulia said that scaling this model will require addressing significant policy and financial barriers. The study demonstrated what is possible under ideal conditions; such a high level of support isn’t typically available in OTP programs. AbbVie Inc., which funded the study, also provided the DAA—sidestepping the insurance hurdles that bar so many low-income people from treatment. Abbvie manufactures Mavyret, one of the most widely used DAA.

“In states that still have prior authorization requirements for Medicaid approval of hepatitis C treatment, it will be critical to have [them] removed for OTPs to even begin to consider integrating hepatitis C treatment into their routine care,” Falade-Nwulia said.

Image (cropped) via New York State Department of Health

The post Partnering With Methadone Clinics “Transforms” Hep C Care, Study Finds appeared first on Filter.

She introduced HR 5629 in late 2025. The bill states, “To provide that the final rule of the Department of Health and Human Services titled, ‘Medications for the Treatment of Opioid Use Disorder’ except for the portion of the final rule relating to accreditation of opioid treatment programs, shall have no force or effect.”

SAMHSA’s 2024 final rule sped up the timetable for methadone patients to “earn” take-home medication. It allowed patients to receive up to seven days of take-home doses during the first 14 days of treatment, and to receive 28 doses within a month. When implemented, this has been life-changing for people who would previously have been tied to daily clinic visits, with all the disruption and surveillance that entails.

Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisiscontinues.

SAMHSA’s 2024 made permanent the loosening of restrictions that was temporarily introduced during the COVID-19 pandemic. It additionally allowed patients to be admitted to an opioid treatment program (OTP) without having to show at least a one-year history of opioid dependence, and permitted initiation of treatment with methadone or buprenorphine via telehealth.

Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisis continues.

In March, the House Energy and Commerce Subcommittee on Health held a hearing on the bill. Houchin stated: “Medications like methadone are effective for some, but are also associated with serious risks, including respiratory depression, cardiac complications, potential for misuse and diversion and dangerous interactions with other substances, particularly in today’s environment where illicit drugs are increasingly potent and unpredictable.” She also falsely claimed that methadone-related overdose deaths increased during the pandemic as a result of SAMHSA allowing more take-home medication.

Her statement is classic scaremongering and ignores decades of evidence that show the efficacy of methadone—and crucially, that its use reduces overdose deaths by over 50 percent. The medication is the gold standard of treatment, has been studied for over 40 years, and is used safely by millions of people around the world.

The problem with methadone isn’t diversion or dangerous interactions, it’s accessibility. The medication is locked inside of clinics that make it difficult to enter and to stay in treatment because of rigid rules like daily dosing, constant urine testing, mandatory counseling and limiting take-home medication.

Houchin’s questions insinuated that strict regulations were needed to decrease methadone-involved deaths and stop diversion. Those DEA talking points have been debunked.

At the hearing, Rep. Houchin questioned Dr. Yngvild Olsen, the former director of SAMHSA’s Center for Substance Abuse Treatment, who was centrally involved in writing the updated guidelines. Houchin was openly hostile to Olsen, instructing her to answer questions with only a yes or a no.

Her questions insinuated that strict regulations were needed to decrease methadone-involved overdose deaths and stop diversion. Those Drug Enforcement Administration talking points have been debunked by numerous studies, conducted during and after the pandemic.

Though the updated SAMHSA rules relaxed some restrictive regulations, here’s the catch: They are only recommendations, and are unenforceable. It’s up to each OTP to decide if they want to enact any of them. Many do not, especially when it comes to more take-home bottles.

So why is Rep. Houchin pushing a bill that repeals unenforceable regulations? Her office did not respond to Filter’s requests for comment.

The Drug Policy Alliance is among many organizations that support the updated SAMHSA guidelines and warn of deadly consequences from Houchin’s bill.

“Nullifying these parts of the final rule would have devastating impacts on people trying to access medication by reinstating barriers to treatment.”

“The Drug Policy Alliance opposes HR 5629, which would nullify updated rules that the communities we represent fought for,” Daniel Fishbein, policy manager for DPA’s Office of Federal Affairs, told Filter. “Nullifying these parts of the final rule would have devastating impacts on people trying to access medication across the country by reinstating barriers to treatment for opioid use disorder.”

“Currently, 80 percent of US counties do not have an OTP, meaning many people who are prescribed methadone must travel hours and wait in line just to get one daily dose,” Fishbein continued. “Eliminating take-home doses could make it impossible for someone who relies on this lifesaving medication to continue care—putting people’s recovery at risk, throwing them into painful withdrawal, and potentially driving them back into the illicit market.”

The American Association for the Treatment of Opioid Use Disorder (AATOD), the trade organization that represents OTP interests, submitted a Statement for the Record expressing “serious concerns” about HR 5629. Over 25 organizations signed on.

“We oppose the elimination of the SAMHSA regulations,” AATOD President Mark Parrino told Filter. “The Congresswoman [Houchin] does not seem to like methadone treatment.”

AATOD’s opposition should be seen in light of the fact that updated regulations make it easier for more people to enter treatment, which increases clinic profits. For AATOD, the SAMHSA guidelines don’t really matter; clinics retain total control over patients and a monopoly on the dispensing of methadone.

The American Society of Addiction Medicine sent a conciliatory letter to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.”

The Legal Action Center sent a strongly worded statement opposing HR 5629 and urged Congress not to pass the legislation. The American Society of Addiction Medicine (ASAM) sent a conciliatory letter directly to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.” ASAM recommended she endorse the Modernizing Opioid Treatment Access Act, a flawed bill that limits office-based prescribing of methadone to a small group of specialists and would increase racial disparities in access to the medication.

Houchin’s bill is an extraordinary intrusion into the medical practice of providing medication for opioid use disorder. But so are the involvements of SAMSHA; of the DEA, which registers and regulates OTP; and of the 50 State Opioid Treatment Authorities that license clinics and often enact yet more inhumane regulations.

Current regulations in Houchin’s home state of Indiana are among the most restrictive in the nation. The maximum number of take-home methadone doses permitted there is 14. The number of clinics allowed to operate in the Hoosier state is capped at 27. And opening an OTP requires a “certificate of need” demonstrating why it should be opened—which allows not-in-my-back-yard (NIMBY) groups to mobilize against new clinics.

Opioid treatment programs, highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians to repeal even modest reforms.

Houchin voted for the passage of the “One Big Beautiful Bill” that will cut nearly 1 trillion from Medicaid over 10 years. Medicaid is the largest payer for substance use disorder treatment in the United States, and around 40 percent of people with opioid use disorder rely on the program for health coverage.

Opioid treatment programs, because they are highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians like Houchin to repeal even modest reforms and to keep methadone locked in carceral clinics where patients are surveilled and punished for any rule infraction.

The only way to end these legislative attacks on people who take methadone and to free them from opioid treatment prisons is to end the separate and unequal clinic system, allow all health care providers to prescribe methadone, and integrate the medication into health care and community settings.  

Photograph by Helen Redmond

The Influence Foundation, which operates Filter, previously received a restricted grant from DPA. Filter‘s Editorial Independence Policy applies.

The post Federal Bill Would Roll Back Modest Progress on Methadone Access appeared first on Filter.

Aversion therapy—often involving pairing an alcoholic drink with an emetic, to condition an association with nausea—had proved highly effective for many patients who were voluntarily seeking abstinence, as Filter described in March 2023. By the 1980s, dozens of hospitals were offering it. 

The complete erasure of aversion therapy is disempowering, because it narrows people’s choices.

However, the advent of managed care led to ever-increasing competition for an ever-declining pool of patients whose insurance would pay for treatment. This led to the treatment wars of the 1980s, where each treatment modality claimed to be the best and denigrated the others as worthless. The Raleigh Hills chain of aversion therapy hospitals fell victim to political chicanery in that period and went out of business. Schick Shadel Hospital suffered a similar fate decades later, through a combination of mismanagement and COVID-19.

It is increasingly accepted today that there are multiple pathways to recovery. It’s not a one-size-fits-all proposition. Rather, different things work for different people. The complete erasure of aversion therapy is disempowering, because it narrows people’s choices. 

Richard St. Peter, who benefited from aversion therapy himself, is the former CEO of Schick Shadel Hospital. He’s also in the early stages of working to reopen it. Filter’s interview has been lightly edited for length and clarity.

Kenneth Anderson: How did you first get involved with aversion therapy for alcohol use disorder?

Richard St. Peter: I realized that I had a problem with alcohol by the 1970s. I tried AA, but it wasn’t really helpful for me because it did nothing for my cravings. Then a friend of mine took the aversion treatment at Raleigh Hills, which operated a chain of 28 aversion treatment hospitals, mainly on the West Coast. 

I was afraid that if he quit drinking, he wouldn’t be any fun anymore, but quite the opposite was true. He out-hunted, out-fished and out-dived all of us who were still drinking, and took our money playing poker. So in 1982, I decided to take the aversion treatment at Raleigh Hills myself.

KA: And how did that work out?

RSP: It was amazing! The aversion therapy took away all my cravings for alcohol completely! I stayed abstinent from alcohol for 11 years until 1993. My training is in finance, and during that time I served as CFO and executive vice president for a number of companies.

KA: What happened in 1993?

RSP: I was at a casino in Las Vegas playing poker, and I ordered a virgin bloody mary. It took a very long time for the drink to come, and when it finally did, I gulped it down because I was thirsty. But it didn’t taste right, and I told the waitress, “I think this tomato juice is rotten.” 

And she said, “No, that’s a bloody mary.” And I said, “A real bloody mary with alcohol?” And she said, “Yeah.” And I said, “I wanted a virgin bloody mary.” And she said, “Okay, I’ll bring you a virgin bloody mary.” 

A short while after that, for the first time in 11 years, I felt the buzz, and I said to myself, Well, that was stupid drinking that. And, the next day, for the first time in 11 years, I felt the cravings come back. And I thought since my career was going so good, my family was doing so good, everything was going so good, that I could become a social drinker.

“The Schick Shadel treatment worked for me when nothing else did … I believe in multiple pathways; different things work for different people.”

KA: How did that work out?

RSP: Badly. In less than a month, my drinking spiraled out of control. I woke up one morning in a pool of vomit with no idea where I was, and that’s when I realized that I had retriggered uncontrollable alcoholic drinking.

KA: What did you do then?

RSP: Well, I tried contacting Raleigh Hills, but I found out that they had gone out of business due to some rehab politicking. But then I found out that Shick Shadel in Seattle was in business and offering the same kind of aversion treatment. It was actually Schick Shadel that had first pioneered the aversion treatment for alcohol use disorder. So, I took two days of the conditioning treatment at Schick Shadel, and have never drank since.

KA: How did your connection with aversion treatment continue?

RSP: I did well in business; I got lucky and I retired in 1998, and I started joining pay-it-forward types of activities, like alumni associations for my schools, hospitals, and businesses that put me on their boards because they thought I would help them out. That’s when I was contacted by the Schick Shadel Hospital Foundation. 

They called me up and asked me if I would join. I said, Sure, I’d love to. I went to Seattle, and I was at a foundation meeting, and afterwards the hospital administrator got me and said, “I hear you’re a finance guy. We have a controller here, and we’re bouncing checks and I can’t understand his explanations. Could you come and talk to him?” I said, Sure. And we went to his office. 

His office had a front door and a back door, and when he saw me come in the front door, he went out the back door, and we never saw him again.

The hospital administrator asked me if I could just stay on for a little bit and kind of get things sorted out until we could get a replacement. I said I would do that, and I looked at their financial statements and saw that they were indeed in deep trouble. I figured out what their problem was and got them a positive cash flow within a month. A month later, the partners that owned Schick Shadel asked me if I would like to buy in. They had some shares left, and I said yes. After that, I started buying up any shares that anyone wanted to sell. That’s when they asked me to be their CEO. I stayed on as CEO until 2011.

“We could reopen as a nonprofit. I would like to make the Schick Shadel program available to anyone who could benefit from it.”

KA: Why did you leave?

RSP: Well, the Great Recession of 2008 hit, and the majority of the stockholders decided to sell Schick Shadel to Ascend Health Corporation in 2011 because Ascend Health was willing to pay them 14 times their original investment. Then, in 2012, a hospital mega-corporation named Universal Health Services, Inc. bought Ascend Health Corporation and replaced experienced addiction management with big corporate managers. 

When COVID-19 hit, the new management, unlike other hospitals, allowed medical staff to remain employed but not come to work. The census dropped, and that’s why Schick Shadel closed on June 30, 2022.

KA: And why do you want to reopen Schick Shadel?

RSP: The Schick Shadel treatment worked for me when nothing else did. My kids went through some of the best-known rehabs in the country without being helped, and then they tried the Schick Shadel program, and that’s worked for them. And now I’ve got grandkids, and I’d like the Schick Shadel program to be there for them, too, if they need it. 

I believe in multiple pathways; different things work for different people. Some people do great with AA, but others need a different kind of a program. 

KA: And what do you need to do to reopen Schick Shadel?

RSP: Well, I have money to invest, but not enough to do it all on my own. So I need to find some investors who are interested in a solid, steady return on their investment. Schick Shadel was a very profitable business for over 80 years, until these problems with COVID and management that I mentioned.

Or, if we could find a foundation to back us, we could reopen as a nonprofit. I would like to make the Schick Shadel program available to anyone who could benefit from it.

Photograph (cropped) via GetArchive/Public Domain

The post Could Aversion Therapy for Alcohol Use Disorder Make a Comeback? appeared first on Filter.

The legislation, titled the “Innovative Therapies Centers of Excellence Act of 2025,” or S.4031, seeks to designate at least five VA medical facilities as specialized hubs for research and clinical care. Under the proposal, $30 million would be appropriated annually to fund these centers, which would focus on substances such as MDMA, psilocybin, ibogaine and DMT to treat conditions ranging from post-traumatic stress disorder to chronic pain.

The bill was introduced by Senators Ruben Gallego (D-AZ) and Dave McCormick (R-PA) on March 9.

“Too many veterans are suffering without effective treatment options,” Gallego, a Marine Corps veteran, said in a statement accompanying the bill’s filing. “If emerging therapies like psychedelics show promise, we have a responsibility to study them and ensure veterans have access to the best possible care”.

“The VA can serve as a national proving ground … that could ultimately benefit patients across the entire health care system.”

To ensure high clinical standards, the designated facilities would be required to maintain affiliations with accredited medical schools, or schools of psychiatry and social work—partnerships that would be intended to provide specialized training.

The initiative is supported by veteran advocacy groups that see it as a necessary evolution of the VA health care system. 

Melissa Lavasani, founder and CEO of the Psychedelic Medicine Coalition, believes it has wider significance, as well.

“This legislation represents more than a research initiative; it’s a step toward building the clinical and policy infrastructure needed to responsibly integrate innovative therapies into modern health care,” Lavasani said. “The VA can serve as a national proving ground, helping generate the evidence and care models that could ultimately benefit patients across the entire health care system.”

Sen. McCormick said the bill would help the federal government catch up with rapid developments in the private pharmaceutical industry. In an interview with Military.com, he  emphasized the importance of closing treatment gaps for veterans.

The legislation specifically targets “covered conditions” including depression, anxiety, bipolar disorder and substance use disorders, in addition to PTSD.

If the bill becomes law, it “will ensure the VA keeps pace with the private sector by expanding access to cutting-edge treatments like MDMA-assisted therapy,” McCormick said. “We owe them nothing less than our very best.”

The legislation specifically targets “covered conditions” including depression, anxiety, bipolar disorder and substance use disorders, in addition to PTSD. 

“The bill was developed through consultation with stakeholders to ensure the framework reflects both scientific rigor and the real-world needs of veterans,” Amy Rising, a United States Air Force veteran and advocate with direct knowledge of the drafting process, told Filter. She added that the result is a “structured pathway” for the VA to evaluate promising new treatments.

Jay Kopelman, CEO of the veteran-oriented Mission to Live Foundation, heralded S.4031’s filing as a watershed moment. A retired Lieutenant Colonel in the US Marines, he has advocated in support of the bill alongside Lavsani and her organization in recent months. 

“Passing legislation that mandates the research and clinical trials of psychedelic medicines in the VA health system is a quantum leap forward in finally getting veterans access to the life-changing care that they so richly deserve here in the US,” Kopelman told Filter. 

“I thank Senator Gallego and all who support this Act for their courage and recognition that we have a crisis in our veteran population,” he added. “As a former Marine, Senator Gallego knows and understands this better than most.”

The introduction of S.4031 follows a November 2025 announcement by the VA that nine facilities—including locations in Los Angeles, San Diego and the Bronx—are already participating in multi-year studies on psychedelic compounds. 

In terms of the broader landscape of federal psychedelic policy reform efforts, S.4031 arrives alongside its House companion bill (HR 2623) as the third major piece of psychedelics-related legislation filed in the current session.

In December 2025, Sens. Cory Booker (D-NJ) and Rand Paul (R-KY) introduced the Freedom to Heal Act. It proposes expanding 2018’s federal Right To Try Law, which granted eligible patients with life-threatening conditions legally-protected access to certain drugs that haven’t been FDA-approved—including Schedule I substances under DEA jurisdiction, like psilocybin, ibogaine and MDMA, that have undergone at least one round of Phase I clinical trials. 

While the Freedom to Heal Act has garnered a number of endorsements from high-profile psychedelic and veteran advocacy organizations, it appears unlikely to advance further. Leaked email correspondence from the Senate Veteran Affairs Committee indicated that the bill lacks the necessary support, as DoubleBlind Magazine reported in February.

Photograph (cropped) of VA hospital in San Antonio by Bill Hathorn via Wikimedia Commons/Creative Commons 3.0

The post Bill Would Require the VA to Study and Provide Psychedelic Treatments appeared first on Filter.

Harm Reduction Approaches With Adolescents Who Use Substances, a new book by Amanda Reiman and Barry Lessin, is a much-needed corrective to conventional, violent and failed ways of working with young people who use drugs. They dismantle the cruel and ineffective concepts of tough love and zero tolerance. They critique the disease theory of addiction, detailing why it can’t explain adolescent drug use and causes enormous harm. 

The authors make a convincing case to stop punishing and shaming adolescents, and instead seek to understand drug use in the context of this developmental life stage. Using the scaffolding of the eight principles of harm reduction, their approach centers on respect, dignity, meeting teens where they’re at, and the nonjudgmental and noncoercive provision of services.

One of the most pernicious problems the book addresses is how drug prohibition and associated “just say no” messages deny young people basic knowledge of drugs. Widespread misinformation puts them at risk, and the nuance of a spectrum of drug-related challenges is lost in the rush to panic about any use. The book explains that a harm reduction approach assesses where a young person is on that spectrum, and how that may inform consensual treatment.

“The goal is not to force behavior into compliance, it’s to build trust and reduce harm in the real world.”

Another strength of the book is it rejects the outcry over teen nicotine vaping, recognizing that it can be harm reduction for teenagers, too. The first section of the book, written by Reiman, states that, “While many adults use e-cigarettes as a form of harm reduction to cut down on smoking, teens may be using them for different reasons but still in the context of harm reduction.”

The second half of the book is written by Lessin, who has been a practicing psychologist and a certified alcohol and other drug counselor for 40 years (he has also written for Filter). It includes instructive case examples and teaching points to illustrate how creative and affirming harm reduction can be in working with adolescents and their families.

The ideas developed in Harm Reduction Approaches With Adolescents Who Use Substances need to become the standard of care. Filter’s interview with Barry Lessin has been lightly edited for length and clarity.  

Helen Redmond: What are some of the problems with the traditional approach to working with adolescents who use drugs?

Barry Lessin: Mainstream models have leaned heavily on abstinence, compliance and diagnosis, often at the expense of understanding context and relationship. These models tend to treat substance use as the primary problem rather than as a behavior that may be a function of regulation, mood, connection, escape, identity formation within a much bigger developmental and systemic picture. This framing acknowledges the reality that adolescents are still forming their identities, learning how to regulate emotion, navigating power, belonging and autonomy. So treatment that doesn’t understand this ends up feeling punitive or alienating to young people, and disempowering families.

HR: Explain the harm reduction approach to adolescence substance use.

Dr. Patt Denning developed a model of harm reduction therapy. It’s a classic and it’s proven to be very effective. Patt allowed me to adapt it for working with adolescents. It’s a rigorous, ethical, relational approach. It starts with respect for autonomy, ambivalence, lived experience and the protective functions that behaviors might serve during adolescence. It means centering safety, collaboration, small and incremental change, rather than control. 

The goal is not to force behavior into compliance, it’s to build trust and reduce harm in the real world. You can have boundaries about adolescent substance use while still meeting young people where they are, and without moralizing.

Harm reduction therapy centers engagement through a therapeutic alliance. Change happens in the context of relationships and adolescents change most through trusted relationships, not through pressure. Harm reduction therapy looks at drug, set and setting. Adolescent behavior is shaped by peers, family, and school, not just individual choice.

Development also includes experimentation, so learning happens through trial and error. So we should expect experimentation and setbacks. Kids learn by trying, overshooting, recalibrating, and punitive responses will just interrupt that sense of learning.

Kids are figuring out who they are. Harm reduction therapy supports agency and self-definition, which is in alignment with identity formation. It emphasizes better skills and supports before demanding behavior change, which helps kids develop self-regulation over time.

Parents get so upset. Why isn’t my kid listening to me? Why is my kid behaving like this? Why is he just continuing to sabotage or hurt himself? The parents forget that kids are not adults, they’re kids! Young people are sensitive to shame and stigma, so harm reduction approaches don’t use shame or moral judgments because it increases secrecy and risk.

“You can’t do much of anything when things are fear-based, especially parenting. If you’re scared, you get backed in a corner and lose your sense of instinct.”

HR: Why do parents freak out when they find out their kids are using drugs, and what are the mistakes they make in addressing it?

BL: So a lot of it comes from drug policy, and how it filters down into our culture, to how parents are educated, by what to expect about drug use and the role of stigma.

I tell my parents you don’t have to reinvent yourself as parents. Most have an instinct of what they know is best for their kids. They have a sense of values and principles that they are already imparting in their relationship with their kids. When they hear about drugs, the messages of, My kid is an addict, he needs rehab, the fear and panic sets in.

You can’t do much of anything when things are fear-based, especially parenting. If you’re scared, you get backed in a corner and lose your sense of instinct. And the messages that are coming from our culture are the messages that something is wrong and you need to get tougher. They are prohibition-based myths. I think the all-or-nothing narrative that is embedded in our culture does a lot of damage.

What do parents do? They either go along with what they’re taught or, if that fails, they think something is wrong with them. That is what our drug policy does to parents and families.

One of the things that I talk to parents about is the CRAFT approach, which stands for community reinforcement and family training. It’s a model used for families that have a member who is using substances. It helps them learn communication skills to have conversations based on engaging their kid where they’re at, and to realize that they’re using substance for reasons. An important idea in CRAFT is to understand that substance use is about a relationship with drugs, as opposed to having a drug problem.

HR: In the media we are constantly hearing scary stories about drugs and the adolescent brain. What’s your take?

We know that the adolescent brain is highly neuroplastic. It’s open to being shaped by experience, relationships, habits and environments. The systems for impulse control and long term planning are still developing and the two triggers for reward and peer sensitivity are really active. There are physiological reasons that adolescents like to take risks. It’s a normal process. So that combination is why they are more drawn to novelty and short-term relief, including substances—and why supportive relationships, structure and stigma-free guidance can have a huge impact. 

HR: In the book you say that harm reduction views vaping as a safer way to consume nicotine. That’s a controversial position when it comes to youth. 

BL: In the book we say vaping for adolescents isn’t safe, it’s safer than smoking combustible cigarettes. For kids who already smoke, switching to vaping can reduce exposure to the most dangerous chemicals in cigarettes, but for kids who don’t smoke, starting to vape obviously introduces some risk.  Harm reduction for tobacco is about assessing risk.  

“We criminalize people who use drugs, attach moral failure, and teach families that even one-time use means addiction and a ruined future. That framing doesn’t match reality.”

HR: What is the impact of social media on adolescent drug use?

BL: One of the influences that was good timing for the book, is the work of Jonathan Haidt. He’s a social psychologist who has developed a very strong body of research that shows how the iPhone and social media has really contributed to significant mental health and substance use issues among teens.

When we look at social media, we connect it to substance use through the same developmental lens that Haidt describes. Social media is built to hook a reward-sensitive adolescent brain that’s still developing impulse control. And social media amplifies peer comparison, social pressure and compulsive rewards, which increases stress, sleep disruption and emotional dysregulation. So it’s the same conditions that often drive kids towards substances as a coping strategy. It normalizes risky behaviors. Part of dealing with social media from a harm reduction approach is accounting for the digital environments that can shape substance use. 

HR: Who is your book for and what do you want them to get out of it?

BL: We wrote the book because of the way that drugs are talked about in the United States, especially when it comes to young people using drugs. It’s built on fear and stigma and punishment, rather than public health and safety. We criminalize people who use drugs, attach moral failure, and teach families that even one-time use means addiction and a ruined future.

That framing doesn’t match reality. At the same time, parents are terrified, understandably, because the consequences of drug charges and stigma are real and lifelong. We wrote it for anyone who has a stake in adolescent well-being; therapists, school counselors, health care providers, educators, caregivers and parents. Anyone who’s sitting with kids in clinics or classrooms or living rooms or community programs. The book is for people working with adolescents who know that the standard playbook is not working.

Photograph by Helen Redmond

The post Beyond the Panic: A Harm Reduction Lens for Teen Drug Use appeared first on Filter.

RESET, which will receive health department funding but operate under the authority of the sheriff’s office, is billed as an alternative to jail and hospitalization. It’s slated to operate as a pilot for 26 months with the option of a one-year extension, and to open its doors in April at 444 Sixth Street in the SoMa neighborhood, across from the county jail.

The center is expected to have 25 reclining chairs where people arrested for public intoxication can be dropped off and can remain for up to 24 hours. Then they’re supposed to be given the option to transfer to a stabilization center, where they could stay for up to 90 days while receiving mental health and substance use services. 

Though officials have characterized the initial 24-hour period as non-carceral, the sheriff’s office has warned that “people who leave early and remain intoxicated and disorderly could be arrested again.” Connections Health Solutions, meanwhile, would receive financial incentives based on how many people are deemed sober, how many stay up to 24 hours even after being deemed sober, and how many are linked to services after the 24-hour period expires.

“The RESET Center allows our officers to arrest those using drugs in public at a speed and volume we have never seen before,” Lurie stated. “And with this new resource, we will also give those suffering from addiction a real chance to choose recovery.”

“At that point, Sheriff Miyamoto said the quiet part out loud. ‘This is what used to be called a drunk tank.’” https://t.co/rRU6AlQJg1

— Susan Dyer Reynolds (@SusanDReynolds) February 12, 2026

Earlier in February a Board of Supervisors meeting became contentious after Mission Local published a leaked memo from the city attorney’s office. 

The memo warned that the proposed facility carried “very high legal risk” because it did not meet legally mandated requirements regarding “safety checks, health care and food services.” It cautioned that people brought to RESET could sue the city for “non-compliance with standards for detention facilities.” The board still voted 9-2 to approve the RESET contract, which Lurie has now authorized.

“Let’s call it what it is,” Supervisor Connie Chan, one of the two dissenting votes, told colleagues. “People will be detained in this space and it’s not voluntary … With additional information [from the leaked memo] it makes me deeply question the operation model and its legitimacy.”

Supervisor Jackie Fielder, the other dissenting vote, noted that the $14.5 million RESET contract was inked at the same time that $17 million cuts were made to vital Department of Public Health programs. “I will not be supporting spending city funds for new sheriff’s facilities that come at the expense of community health programs,” she told her colleagues.

Supervisor Matt Dorsey, who represents the city’s SoMa neighborhood, said he was launching an investigation into the memo leak and would pursue censure of any fellow supervisor found responsible. 

According to the San Francisco People’s Budget Coalition, the $17 million DPH cuts will gut services designed for marginalized groups, including harm reduction services.

“During a budget year where we’re going to see austerity cuts to vital social services, we can’t be spending $14 million on needlessly bringing in an out-of-state entity to administer systems already in place within our city’s own Department of Public Health,” District 8 community member Evelyn Posamentier wrote in an open letter. “We have treatment services that work, but are burdened by bureaucratic barriers and underfunding. Why would we spend such a huge price tag on something that only temporarily addresses street conditions?”

Public documents show that the sheriff’s office proposed to contract with ConnectionsCA LLC, a subsidiary of Arizona-based Connections Health Solutions, which subsequently filed paperwork on October 31, 2025.

Three local organizations had initially applied. But only Connections ultimately moved forward with the process, according to a January 30 report by the city’s legislative and budget analyst. No explanation was given as to why the other organizations dropped out. 

In addition to the costs of running the RESET pilot, the report stated that over the initial term, stationing two police officers as security at all times would run the sheriff’s office an additional $4.3 to $4.9 million.

Notably, while the legislative and budget analyst’s office clearly recommended other items in its January report, it withheld a similarly clear recommendation for RESET, writing only that “[a]pproval of the proposed resolution is a policy matter for the Board of Supervisors.”

At $238,000 per bed per year, the Connections proposal was 52 percent higher than that of the lowest bidder. And because the company is new to contracting in California, it won’t be able to bill Medi-Cal for at least six months, during which time the city will be paying top dollar for a facility that’s largely focused on streamlining police operations. 

“In modern times, to spend $14 million on a dressed up drunk tank is truly a shocking waste of resources,” Jennifer Friedenbach, director of the Coalition on Homelessness, wrote in a February 3 letter to the Budget and Finance Committee.

Image via City and County of San Francisco

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