SAN FRANCISCOMEDICINE - California Society of Addiction ...

Public Health Report
Robert P. Cabaj, MD, and David Hersh, MD
SFDPH Public Sector Services for
Substance Use Disorders
San Francisco citizens have a wide array of services to help
with substance use-related problems and disorders. Primarily
targeted for people with little or no insurance or
who are covered by Medi-Cal, Medicare, or a combination of the
two, services range from substance use assessments, treatment
planning, and brief interventions at the extensive Department of
Public Health (DPH) Community Oriented Primary Care Clinics
(COPC) to the network of specialized substance abuse treatment
modalities for serious and persistent substance abusers offered
through DPH Community Behavioral Health Services (CBHS).
The specialty substance abuse services are provided mainly
by community-based organizations, under contracts with CBHS.
Since 2000, San Francisco has had an official Harm Reduction
Policy that applies to the health department and all contractors
who deliver substance use, mental health, sexually transmitted
diseases, and HIV/AIDS treatment and prevention services, and/
or who serve drug and alcohol users in their programs. In addition,
since 2003, when CBHS was organized by combining mental health
and substance abuse administrations, the vision of the Department
has been, “Any door is the right door”—meaning that any client
or family seeking services can be seen and assessed at any site
operated by or contracted to CBHS. If a particular program does
not offer the level of care needed, that program will make sure
the client or family is referred to the proper site and engaged. An
open-access policy means all people seeking help will be seen in
forty-eight hours or less, so there are no waiting lists except at some
residential care programs. If a client has to wait for a residential
program, he or she will still be engaged by the referring provider
with support services.
People can seek services by walking into any community
clinic or by going to the Behavioral Health Access Center at 1380
Howard Street (at 10th Street), which houses the Treatment
Access Program (which serves as the gatekeeper for residential
services) and the Access Team (which screens for mental health
and substance abuse concerns). People can also get information or
be screened for referrals by telephoning the central access line at
(415) 255-3737. Other ways of accessing care are through any of
the COPC sites and through programs such as the Homeless Outreach
Team and Project Homeless Connect, which target homeless
clients who often need substance-abuse services.
To better coordinate patient assessment and placement into
the City’s wide array of funded substance use, dual diagnosis,
and mental health services, the Behavioral Health Access Center
(BHAC) was created in 2008. The BHAC represents the colocation
and integration of several formally separate City substance
use and mental health evaluation, stabilization, and treatmentlinkage
services, including the Treatment Access Program (general
substance use and dual diagnosis), Centralized Opiate Program
Evaluation (COPE) Service (methadone and buprenorphine),
Mental Health Access Program, and the Buprenorphine Induction
Clinic. The CBHS Pharmacy, also housed at BHAC, provides
psychotropic medications to patients seen at City mental health
clinics and BHAC, as well as Suboxone to patients enrolled in the
City’s buprenorphine program.
Patients presenting to BHAC receive a thorough biopsychosocial
assessment that guides the determination of the level of care
and treatment modality most likely to meet the patients’ needs. In
addition, staff give consideration to which specific programs would
best meet each patient’s particular needs, taking into account such
factors as gender, language capacity, ethnicity, race, sexual orientation,
housing needs, family connections, and other relevant factors.
DPH provides funding for primary and secondary prevention,
detoxification (social model and residential medically assisted),
outpatient (intensive and low-intensity, including medication
management and smoking cessation treatment), opiate agonist
treatment (methadone and buprenorphine), drop-in, drug court
and other criminal justice follow-up, and residential (substanceuse,
dual diagnosis, mental health) services. Patients are referred
to BHAC from programs and services across the City, including
primary care, mental health, case-management, substance-use,
and homeless outreach.
DPH funds thousands of treatment slots and beds across the
City, including more than 2,200 methadone and 200 buprenorphine
maintenance slots. To expand and enhance access to these
opiate-agonist treatment services, DPH has implemented several
extremely innovative programs, including a Mobile Methadone
Van, an Office-Based Methadone Pilot Program (also known as office-based
opiate treatment or OBOT), a centralized opiate agonist
treatment assessment/linkage service (COPE), and the Integrated
Buprenorphine Intervention Service (IBIS). The methadone vans
www.sfms.org June 2010 San Francisco Medicine 37