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Mayor declares a state of emergency in San Francisco's Tenderloin district

STEVE INSKEEP, HOST:

San Francisco has won praise for its handling of the pandemic, a bit less so for tackling another public health crisis - drug overdoses and related disorder. Mayor London Breed announced an emergency plan last month for the part of the city known as the Tenderloin. She said that overdoses, drug dealing and street chaos were, quote, "totally out of control," and she promised tough love for those who break the law. NPR's Eric Westervelt asked how it's working.

ERIC WESTERVELT, BYLINE: Mayor Breed's emergency order certainly risks undermining San Francisco's reputation for tolerance and City Hall's pledges to deemphasize policing to solve problems. But many residents and businesses here strongly back the mayor's call to, quote, "take back our Tenderloin."

RENE COLORADO: They're tired of open-air drug dealing, seeing other people suffer and die on the street from drug overdoses, and they're tired of crime in the Tenderloin.

WESTERVELT: Rene Colorado, with the Tenderloin Merchants Association, says so far, the city's actions have not meant more cops harassing or sweeping homeless encampments. He's hopeful this is the start of ending what he calls a sense of anarchy afflicting too many of the neighborhood streets.

COLORADO: That's what success would look like to me. It's tough because to do that, you need police. They need to make arrests. And that's something that, for some reason or another, people that don't live in the Tenderloin are uncomfortable with. But residents don't want drug dealing here.

WESTERVELT: The Tenderloin's problems - homelessness, poverty, substance abuse - have been around for a long time, and it's become even more a kind of containment zone for those challenges amid the rise of tech wealth and its staggering inequality. But the pandemic mixed with the spread of a dangerously powerful synthetic opioid have recently made things here even worse.

MATT HANEY: What is new here is fentanyl. That's the state of emergency.

WESTERVELT: City Supervisor Matt Haney lives in and represents the Tenderloin. At a diner near his home. he points out the city is averaging nearly two overdose deaths a day. Over the last two years, the city has seen more than 1,360 overdose fatalities, more than double the total COVID death toll here. And he points out that almost three-quarters of the overdose deaths involved fentanyl.

HANEY: If you're smoking or shooting up fentanyl, that's like Russian roulette. People are dying within minutes or seconds of buying drugs on a corner. And it has ripple effects throughout the entire neighborhood that are devastating.

WESTERVELT: Haney says the city's relatively agile handling of the pandemic shows what can be done when government commits and moves fast to confront a health crisis. The mayor's latest emergency order now helps city departments do just that - light a fire under notoriously lumbering bureaucracies. A centerpiece of the plan is a newly opened linkage center. It's a walk-in, one-stop shop for city services where folks can try to get access to drug, alcohol, mental health and homeless support, and possibly a shelter bed and eventually maybe permanent housing. Mayor Breed.

LONDON BREED: What's so important is that we have solutions and we don't just say, we don't like it, we don't want to see it. This is about trying to help people, and that's exactly what we're going to keep fighting for.

WESTERVELT: Breed says she has no illusions that the new linkage center will quickly transform the Tenderloin, but she hopes it's offering a new lifeline that meets people where they are.

BREED: The fact is, people who struggle with addiction - it's not as easy as they're just going to walk through the door and ask for help, or we can't force them into treatment. Part of the goal is to make sure that they know that there's a place where they won't be judged, and when they're ready for help or assistance, they can get help or assistance.

WESTERVELT: But many of those most affected by the policy shift say, so far, nothing's really changed. Shy Brown says she's lived in the Tenderloin, mostly on the streets, for a decade. She's sitting half in, half out of a small sidewalk tent. Pigeons are busily picking at remnants of a handout dinner. I ask if she's seen changes or even heard about new options.

SHY BROWN: Hell no. I want to know what the strategy plan is and how we're going to execute it, you see what I'm saying? And I don't see that happening. So, no, it's not going to work. It's not going to work.

(SOUNDBITE OF POWER WASHER SPRAYING)

WESTERVELT: Nearby, a man power washes the street after a free lunch giveaway near GLIDE, a nonprofit that provides daily meals and other services to the homeless and poor in the Tenderloin. Jean Cooper, chief strategy officer with GLIDE, hopes the emergency plan and new linkage center result in real change. But she also worries it's just another patch addressing only surface symptoms.

JEAN COOPER: The realities is is the drivers to what we see on the street here are, you know, deep-seated, systemic issues that not only San Francisco struggles with, but, like, you know, major cities across the United States are struggling with right now. And it's around a lack of affordable housing, a lack of access to affordable and quality health care, and that includes mental health and substance use treatment.

WESTERVELT: To underscore the challenges, as if on cue, a homeless man stumbles down the middle of the street, teetering. He's mumbling, no shoes or shirt. His pants are filthy and falling down. He's unresponsive when people approach him. I ask Cooper what might be done.

COOPER: You know, our staff will get him a pair of shoes and a shirt, you know, give him something to eat, sit him down, and they'll watch over him if anyone tries to prey on him.

WESTERVELT: Right. So the guy behind us who's shirtless and passing out - you couldn't actually physically get him to a bed tonight.

COOPER: No. We don't have access to beds, you know? So it's not like we can actually get someone into a bed directly.

WESTERVELT: And maybe that's really the challenge. How does the city turn its emergency order and linkage center into a viable strategy for long-term solutions to long-standing problems, ones that are more expensive and more complicated than the daily wave of triage in the Tenderloin?

Eric Westervelt, NPR News, San Francisco.

(SOUNDBITE OF LEAVV'S "BLUE VIEW") Transcript provided by NPR, Copyright NPR.

Eric Westervelt is a San Francisco-based correspondent for NPR's National Desk. He has reported on major events for the network from wars and revolutions in the Middle East and North Africa to historic wildfires and terrorist attacks in the U.S.