What Prop F means for those receiving cash assistance in San Francisco

• , would establish a drug screening process for those enrolled in the state-mandated General Assistance program to receive benefits — a monthly stipend of $697 for those housed and $105 for those unhoused.

The measure aims to curb The City’s ongoing opioid crisis and comes after San Francisco suffered its deadliest year for overdose deaths since 2020.

“When you look at the overdose data over the last year, or two, or three, or even in January, clearly the treatment system as it is now has some shortcomings,” said Trent Rhorer, the executive director of the San Francisco Human Services Agency. “We’re not moving the needle in that way.”

The Human Services Agency currently runs the General Assistance, also known as the County Adult Assistance Program (CAAP), and would be responsible for the changes implemented by Prop F.

Around 5,300 people are currently enrolled in the program, said Rhorer, and 30% of those are estimated to have some kind of substance use problem, with 20% already declaring it.

It’s that last 10% that Rhorer is hoping that Prop F will identify and then get into some sort of treatment, depending on what the person’s needs are and what they’re willing to do.

“It’s a whole range, from residential treatment to abstinence-based treatment to peer support groups to medically assisted treatment like methadone or buprenorphine,” he said. “If someone’s going to agree to go to treatment, it has to be something that they feel comfortable doing.”

But some feel that the measure is flawed, with one of her more vocal critics, Board of Supervisors Aaron Peskin, calling it a “performative” action by Mayor London Breed as the mayoral election gears up.

“The reality is this deals with a very small sub-segment of the community that is using drugs,” Peskin told The Examiner last month. “The remedy that she’s offering is to kick poor people out of housing onto our streets … It’s not great public policy; it’s just trying to paper over her failure to properly administer her government.”

Some working with lower-income and unhoused residents feel that this type of policy adds pressure to a population already struggling.

“Addiction and drug use and everything that comes with that is a much larger societal problem,” Lydia Bransten, the executive director of The Gubbio Project, a San Francisco homelessness nonprofit, told The Examiner in a previous interview.

“It takes time, like any medical issue, to resolve,” she said. “These punitive responses, they’re not even bandaids; they’re kind of just putting fuel on the fire.”

But public support appears to support the proposition, with a recent San Francisco Chamber of Commerce poll showing that 61% of respondents supported it and 36% opposed it.

Rhorer acknowledges the criticism but said that the proposition wouldn’t force people out into the street.

People are allowed to commit “three failures,” said Rhorer. “Let’s say we refer them to an outpatient support group in combination with buprenorphine, and they don’t show up.”

People who are identified as having a substance use issue and opt not to go into treatment lose their CAP benefit, but the program will pay for the participant’s rent for the next 30 days to avoid them losing their housing.

“They do remain eligible for medical health insurance, they do remain eligible for CalFresh, which is their food stamp benefit, which is about $290 a month,” said Rhorer.

Then, after 30 days, they have the option to reapply.

The agency already has staff capable of conducting the assessments, which will not include drug testing of any kind, said Rhorer, but additional staff will likely be hired if the measure passes.

“We’re probably going to add a couple of clinicians to do the evaluation and coordinate the treatment plan,” he said. “Then we’re working with public health to see how much capacity we might need to add and human services versus what we can use when for the existing system.”

The evaluation will include additional questions for the employability assessment that the agency has already conducted with participants found in the Drug Abuse Screen Test (DAST-10), a questionnaire to evaluate drug use in the last 12 months.

Most of the staff are already in the medical field, including nurse practitioners and clinicians, so whatever additional training would be needed if Prop F were to pass would be minimal, said Rhorer.

While there has been some concern recently about the treatment bed capacity currently available in The City, Rhorer isn’t too worried about the program’s participants flooding the system.

“We get about 1500 applications a month, about 500 of them are eligible and get approved,” he said. “At the same time, we get about 500 people who leave every month.”

If Prop F gets approved by voters next week, it will go into effect on Jan. 1, 2025. The program’s total cost would range from $500,000 to $1.4 million

• annually.

“We’ve already been planning as if it’s going to pass because it’s the smart thing to do,” said Rhorer.

Over the next several months, the agency will finalize the budget and work with the Department of Public Health to determine how it would fit into their current treatment systems.

All new applicants would fall under the new requirement, and those currently receiving benefits would have to comply when they return to recertify their participation in the program, once a month for those who are unhoused and once a year for those who are housed.

“Will 100% of the people who we enroll in treatment succeed?” Rhorer said. “Of course not. It doesn’t happen now in the current system. But I’m certain that it will help some people.”