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A Radical Answer to the Fentanyl Crisis
In July, President Donald Trump issued an executive order calling for an expansion of involuntary commitment—forcing people into treatment facilities—in response to the homelessness crisis. San Francisco has been attempting such an expansion for the past 19 months. What can the rest of the country learn from California? This is the final episode in a three-part series from Radio Atlantic, No Easy Fix, about homelessness and addiction in San Francisco. The following is a transcript of the episode: Hanna Rosin: This is Radio Atlantic. I'm Hanna Rosin. Today, we have the third episode of our series about San Francisco and what it takes to escape homelessness and addiction. Last week, we talked to San Francisco Mayor Daniel Lurie. Rosin: And we followed Evan, who is trying to get off the streets, through a critical 48-hour period. Evan: I don't know where to go. And it's raining, and I'm cold, and I'm hungry (Laughs.) And I'm over it. I'm so over it. Rosin: This week, Evan is missing, and he badly needs medical care. We follow the search for Evan, and we look at a new experiment with involuntary treatment. Here's reporter Ethan Brooks. (Phone rings.) Liz Breuilly: Hello? Ethan Brooks: Hey. Breuilly: How you doing? Brooks: I'm doing all right. You know. Brooks: It's been a few weeks now since anyone's seen Evan. The last time I saw him was late at night, in the Mission District. He needed urgent medical care for his leg, which was swollen and infected, and he planned to go to the hospital. And then he disappeared. Breuilly: He could lose his leg, you know? That's why, when we separated, I was really clear with him—that he understood that his leg was not gonna get better on its own. Brooks: When Liz can't find someone, usually at least someone out there, one of the many missing people Liz has found over the years, has seen that person around. But not this time. Breuilly: No one's seen him. I was like, Yeah, have you seen Evan around? They're like, No, why? Is everything —I was like, I don't know. He's, like, missing, missing. Brooks: Typically, when someone with an addiction like Evan's disappears, it's not some big mystery what they're up to. Evan's best friend, Joe, who lives out in Washington, has been through this more than once. Joe Wynne: I was gonna have him get a tattoo with my phone number on it. Brooks: (Laughs.) That's a great idea. Wynne: Yeah, yeah. (Laughs.) But he disappeared on me. Brooks: But this time is different. When Liz called the hospitals, none of them had any records of Evan. She checked arrest records—no sign of him there either. The shelter where he'd been staying for the past few weeks, they also hadn't seen him. It's one thing to not make it to the hospital or into treatment, but why would Evan stop sleeping at the shelter he's been going to for weeks? [ Music ] Brooks: Are you worried? Wynne: I mean, I expect Evan to die out there—100 percent, that's how this ends: in the streets, in a bad way. As his best friend, I have seen no pieces of evidence that persisted beyond 72 hours of him heading in any other direction, and I've seen 10,000 pieces of evidence of him headed towards death: He's been shot. He's been run over. He's been dead in the street and revived with Narcan, like, umpteen fucking times. Overdosing is, like, a weekend for Evan. So the question is like, What on the list of human experience is left to Evan that he hasn't done? Brooks: Recently, I've been thinking about something Evan told me the first time we met. When Liz asked him what he thought it would take to get clean, he said, 'I can't be trusted. I can't have the privilege to do anything.' Liz put it more bluntly and said, 'You need to be locked in a cell.' At the time, this struck me as sort of tongue-in-cheek, something to acknowledge the seriousness of Evan's addiction. But now that he was missing, and in urgent need of medical care, I was wondering if he actually meant it. Not so long ago, there was a consensus in places like San Francisco that forceful confinement of drug-addicted people, of the type practiced at an astonishing scale during the War on Drugs, was not the path forward. But in the face of the crisis on the street, and the toll of that crisis on the city, San Francisco is expanding a system that would force people off the street and into involuntary treatment. And elsewhere, not so far away, a system of forced care is already in full effect. From The Atlantic, this is No Easy Fix Episode 3, 'A Golden Opportunity.' Sam Quinones: I didn't really want to write about addiction or health or anything about that; I really just wanted to write about Mexican heroin traffickers. Brooks: For someone who didn't want to write about addiction, Sam Quinones has written about it a lot. He was one of the first journalists covering the rise of prescription pain pills and has been covering the opioid crisis in his books—and sometimes in The Atlantic —ever since. In that time, Sam has seen a lot of money spent on solutions to this problem, a lot of ideas tried, and a lot of failure. Quinones: I would say now, after 15 years of this and after watching so many people die, I've gotten to a point where I'm not gonna nod and smile at bullshit. And what we really need to be doing is rethinking how this is done. Brooks: How recovery is done in America is not one cohesive thing. Some people are given the choice between rehab and jail, and choose rehab. Others have been referred from the hospital or pressured by family. You might be able to stay for a few months or just a month, depending on what you can afford and what Medicaid can pay for. What unifies recovery in America are the results. Compared to Western Europe's, our system is more expensive, has higher relapse rates and more overdoses. The reason I called Sam is because now, in the face of such persistent failure, he's part of a growing and surprising coalition of people calling for a different approach. Quinones: I really believe that we have been wasting a magnificent golden opportunity for decades in jail because for so many people, the blessed day was the day they were arrested and they got off the street. A lot of people don't wanna hear that, but in my opinion, that's been a revelation. Brooks: Sam knows, and I know, that for many people, calling jail for drug use 'a magnificent golden opportunity' can be an unpopular position. For as many people as 'the blessed day was the day they were arrested,' there are others for whom such an arrest led to nothing but pain and instability. Historically, up to 75 percent of incarcerated people with opioid-use disorder will relapse within three months of release. Many of them do so having lost their tolerance, which sends the risk of overdose and death through the roof—which is one of the reasons why many people think this is not the way forward. Quinones: That's just nonsense. There's a lot of people for whom it doesn't work at certain times, but the idea that nobody ever found sobriety after being arrested and being forcibly removed from the streets—I mean, I can't tell you how nonsensical that idea is— Brooks: Not so much that nobody ever got sober, but, like, the question of what should be the dominant way that we deal with treatment and recovery. Quinones: Well, I mean, it depends what drugs you're talking about. Marijuana, maybe not. Alcohol, maybe not. With fentanyl, I have to say, I think it's absolutely essential. One of the effects of fentanyl is to turn people into folded people: So they are bent at the waist, their chins are almost touching their shoelaces, almost groveling before the drug, subservient. It is completely domineering and requires you to be taking it all day long. Brooks: Sam's argument is for involuntary treatment—in this case, jail-based recovery pods—not as a means to some other end, but as a tool for individual recovery. Quinones: You just can't get ready for treatment on the street in the time it takes for meth to drive you mad and fentanyl to kill you. Brooks: Sam isn't the only one calling for an expansion of involuntary treatment. Archival (Fox News): President Trump signing an executive order to end homelessness that has taken over public streets. So let's take a look at how he aims to do this. Brooks: A few weeks ago, on July 24, President Trump signed an executive order called 'Ending Crime and Disorder on America's Streets.' The order makes it easier to clear homeless encampments; it blocks funding for safe-injection sites, predicates housing assistance on addiction treatment—and one other major change. Archival (Fox News): It also supports involuntary treatment, which is crucial if you're gonna get people off the streets who don't wanna get off the streets and don't wanna quit drugs. Brooks: Involuntary treatment, or as the order puts it, quote, 'shifting homeless individuals into long-term institutional settings,' end quote. What the order calls for, in short, is an expansion of institutionalization, both for people with severe mental illness and for people with severe addiction, like Evan. It's the sort of thing that doesn't sound very 'San Francisco,' but on the subject of forcing people into long-term care, the city is actually way out ahead of Trump on this one—nearly two years ahead. [ Music ] Susan Eggman: When we closed the state hospitals, we didn't quite realize like, oh, they are serving a purpose. These people are being safely housed here. They have food, they have care, they have shelter, all these things. Brooks: Susan Eggman is a former California State Senator, a Democrat, who served in the Senate from 2020 to 2024. And right out of the gate, Susan set out to make it easier to commit people against their will. Eggman: We swing as a society, right? We were locking everybody up, throwing away the key, for their safety, for our safety. But now we've realized it was not bad to treat people; it's bad to warehouse like we were doing. But there has to be someplace in between. I mean, I tried for years—I couldn't even get hearings in committees, right? Brooks: Oh really? Eggman: The judicial committee would be just like, (Laughs.) Get outta here, Eggman, right? I mean, I'm a huge ACLU lover, right, but they hate me when they see me coming (Laughs.) with this stuff. Brooks: The reason the ACLU is so strongly opposed to changing the law is that it's no small thing to rescind someone's freedom when they haven't committed any crime. America has a long and dark history with this. – a system of asylums and hospitals that would drug, shock, even lobotomize patients. The ACLU calls 'conservatorship,' the present-day system of involuntary commitment in California, 'the most extreme deprivation of civil liberties, aside from the death penalty.' But after years of bargaining and pushing, Susan broke through. In October of 2023, Gavin Newsom signed Susan Eggman's bill—it's called S.B. 43—into law. The law dramatically expanded the pool of people who qualify for involuntary treatment. Now people who can't provide for their own personal safety, or necessary medical care, qualify. So do people with severe substance-use disorder. Neglecting medical care, severe substance-use disorder—that sounds like Evan. Two months after Susan's bill became law, San Francisco put the new rules into effect, while just about every other county in California decided to wait. So now, 19 months into this experiment, with Evan missing, I wanted to see how and if this system might work for him. Brooks: Can you introduce yourself? April Sloan: I'm April Sloan. I am the assistant deputy chief of the Community Paramedicine Division of the San Francisco Fire Department. Brooks: In case you didn't catch that, April Sloan is an assistant deputy chief in the San Francisco Fire Department—also a very fast talker. April's team, called EMS-6, is at the cutting edge of implementing this expanded involuntary system. EMS-6 deals almost entirely in extremes: the most mentally ill, the most uncooperative, and the most severely drug addicted in San Francisco—in short, exactly the people that the city has in mind when expanding involuntary treatment. April sees people who qualify for involuntary treatment all the time—among others, people with severe substance-use disorder and people with chronic medical neglect. Sloan: We see a lot of people with wounds that they're not getting treatment for. Brooks: Yeah. A lot of amputations and stuff? Sloan: I've never seen the amount of amputations like this. It's crazy. Brooks: The way the system is supposed to work is like a ladder: The bottom rung is the police or a clinician or a team like EMS-6. They make an evaluation and recommend that a patient be held for 72 hours and taken to an emergency room. I reached out to the San Francisco Police Department for this story and did not receive a response. Eddy Bird, a captain on EMS-6, does plenty of this. He's spent his whole career on an ambulance—which, before he worked at EMS-6, made Eddy a pretty popular guy. Eddy Bird: When somebody's collapsed and had a heart attack in front of their house, and they're laying on the sidewalk, everybody's real happy to see an ambulance rolling up. And the minute you put somebody in an ambulance, you drive away, everybody's real happy to see you driving towards the hospital. Brooks: When those types of patients arrive at the hospital, everyone knows what to do. But on EMS-6, it's different. Bird: Sometimes they've just got chronic needs, and we keep bringing them to the hospitals, and the staff now at the hospitals is like, Why do you keep bringing them here? Brooks: EMS-6 is sending people to the emergency department for involuntary treatment; the hospitals are sending them right back out to the street. It's possible that individual doctors aren't buying into the new rules—simply don't believe that severe substance-use disorder merits such an extreme deprivation of civil liberty. But it's certain that the infrastructure required to pull off this expansion doesn't yet exist. In the long-term locked facilities meant for involuntary treatment, there is a desperate shortage of staff and beds. This isn't just the case in San Francisco—cities across the country are scrambling to deal with a rise in psychiatric emergencies, including a spike in suicidality among young people. They are struggling to finance an effective response This shortage funnels more and more people into the only place they can go: the emergency department. Sloan: To be clear, EDs are not meant to treat people with psychiatric disorders or substance-use issues. Policy dictates that we have to take them to the hospital for a medical evaluation, so we do that. But then, they are discharged to the street. Brooks: Which leaves Eddy and April and their team trying solutions that feel surreal. April told me one story about a client of theirs that was suicidal—he told them as much. They kept getting 911 calls reporting that he had walked into traffic. EMS-6 would take him to the hospital, and the hospital would discharge him. This happened so many times that eventually one of the captains began to just follow this man around and just stop traffic when he stepped into the street. With no way to keep this client out of oncoming traffic, EMS-6 kept traffic away from their client. Bird: Every day, you go out to people that don't wanna see you, to people that are calling that are angry because you're not fixing the problems, because you don't have the tools or the resources to fix these problems. So some people you've been friends with for a long time start being jerks to you, same thing with the hospitals. Nobody wants to see you. They're like, Oh, you're not doing anything. You're not fixing any problems. You don't fucking do anything. Brooks: Since the adoption of expanded involuntary treatment 19 months ago, the number of people placed into long-term involuntary care has hardly changed. The number of conservatorships initiated solely for severe substance-use disorder is zero. So to the question of if this is a system that might have benefited Evan, the answer is a resounding no. [ Music ] Brooks: Before anyone can think about locking Evan away, and whether that would be compassionate or monstrous, there's one thing that is not up for debate: You can't lock up Evan if you can't find him. And at the moment, no one knows where he is. It's early April now, and Evan has been missing for over a month. The last time they spoke, Liz told Evan that his leg would not improve on its own. She told him to get to a hospital immediately. Then he disappeared. Brooks: So Joe Wynne, Evan's best friend, has flown to San Francisco to find him. Wynne: Look, this is my 'missing' poster for Evan. Brooks: Joe is sitting in Liz's car, showing off a template he's downloaded onto his phone. The word MISSING is in all caps in white and red across the top. Wynne: It's classic, right? But I'm gonna swap out the picture of the cat, obviously. All right, look, I wrote, 'Evan: He's friendly and handsome as fuck. Call me if you see him. His leg is fucked, and he needs medical.' It's a fun flyer. Breuilly: Evan's gonna be like, Where'd you get that picture? Oh, Liz took it of me? Brooks: The picture is not flattering. Evan does not look handsome or very friendly. His hair is in his face, and his skin is blotchy. He looks like someone who's been living on the street for the last five years. Liz took this photo originally with an eye towards the future, with the idea that she might show a clean, sober, housed Evan just how far he'd come, and that an image like this might ward him away from relapse. And now, Joe was about to show it to as many people as he could. Wynne: So I have a photo of me and Evan side by side—that's what I was gonna use. Breuilly: I know, but that looks like him now. Your other one's—he's not happy like that. Brooks: We spend the day driving and then walking around the Mission District and the Tenderloin, tracing wider and wider circles from where Evan was last seen. Wynne: Hey, man, can I ask you a question? This is my brother Evan. I'm looking for him today. He's got a really bum leg and a walker— Brooks: Joe is handing out his flyers and offering a cash reward for whoever finds Evan—this is getting a lot of interest. Joe calls Evan his brother because he's found that people are more likely to help that way. Wynne: We're trying to get him to the hospital 'cause he's got an infection in his leg. Brooks: Liz is going with her lighter-touch approach, asking friends and friends of friends if they've seen him. We see Evan's last name spray-painted on a wall, which feels like a clue, but definitely isn't. As always, people living on the street in the Tenderloin are eager to help. One of them tells Joe, I'm sorry you're going through this, without any irony that I could detect. Brooks: Twelve hours into this search, and Liz and Joe are getting a little desperate. We've been searching all day, Joe has handed out God knows how many flyers, and there's still no sign of Evan. Operator: No, I don't see anyone by [that] name. Wynne: Okay, thank you so much for checking. Operator: No problem. Wynne: There isn't any way—(Phone hangs up.) Well, all right. Can I put, like, a call-back number? Brooks: The hospitals don't have any record of Evan. Liz and Joe are running out of ideas. And then Joe's phone rings. Wynne: Hello, this is Joe. Anonymous: Are you looking for someone? Wynne: Yeah, yeah, I'm looking for Evan. Anonymous: Are you mobile right now or what? Breuilly: Yeah. Wynne: Oh yeah. Anonymous: Yeah, he's right here on Van Ness and Market, man, in front of the donut joint. Brooks: We're only a few minutes away from that intersection. And as we pull up, there's Evan—wearing the same clothes Liz bought him over a month ago, standing on both legs. Joe pulls him into a hug. Evan: Bring in the cavalry. Wynne: (Laughs.) How are you, babe? Just so you know, about 400 people have flyers with your pictures on it. Evan: I saw one of 'em— Breuilly: (Laughs.) Evan: —and I was like, What the fuck is that? Wynne: (Laughs.) Evan: I was like, That's not real. Breuilly: Full disclosure— Brooks: That night, Joe and Evan stay in a hotel downtown. Forty-eight hours later, after a marathon wait in the emergency room, Evan is admitted to the hospital. When I finally got to sit down with Evan, the first thing I wanted to know was where he'd been over the last month, why nobody had seen him. In the month since I last saw Evan, he'd gone from being a thief who'd bring back and sell lots of stolen goods to looking through the trash—for some clothes or a half bottle of alcohol, anything he could sell for a dollar or two. For a while, he convinced a few restaurants to give him abandoned Doordash orders, which he would then barter for fentanyl. But eventually, that stopped working too. He had disappeared not because he'd gone somewhere, but because he'd fallen so far as to be completely out of sight. Two days ago, the day Liz and Joe were looking for him, Evan had decided to lie down. His feet had gone numb, so he wanted to rest—which, in his world, is a big decision: If you spend a full day lying down, you're not making money, and you're inching towards withdrawal. Evan: So I had this tiny, little rice-sized piece of fentanyl, but I didn't have a lighter, and so I kept using that as an excuse all day not to smoke it. Brooks: He had decided to stay lying down, so instead of getting up, he called out, asking for a lighter. But no one helped. And then he had an idea. Evan: Two nights before, I'd found this empty matchbox. And where I happened to lay down, there was two broken matches on the ground. And I went and sit inside my sleeping bag and put that little rice-grain piece of fentanyl on a piece of foil, and I took two hits with the match and then put it out, and then later, I did the same thing with the other match. Brooks: Listening to Evan tell this story, there's a bit of pride in his voice; you can hear that he's smiling. He's proud of having successfully MacGyvered a high out of two matches and a rice grain of fentanyl. Brooks: How does this sound to your ear when you're saying this stuff? Evan: Yeah. (Laughs.) I just can't believe that it would [be] me going through it. It's like, How have you gotten so low, you know? Brooks: Literally lying on the ground. Evan: Using matches that I found in my sleeping bag to hit a piece of rice-grain fentanyl, because my legs are too swollen to get up to walk anywhere. Brooks: Eventually, Evan got up. He hadn't eaten anything all day, and it hurt to swallow. He made his way over to some people he knew and then found one of Joe's flyers. Evan: And then I was like, Oh yeah, that's Joe's making right there. I immediately was like, Facepalm. Like, No, no, no, no, no, no. Brooks: Why 'no'? If you had just had the day that you just described— Evan: Well— Brooks: —I feel like— Evan: Yeah— Brooks: —the answer could be, 'Thank God.' (Laughs.) Evan: No, just because of the embarrassment of, like, I never wanted to be this person on a flyer like that, just my picture all around town like that. Brooks: When the cavalry arrived, in the shape of a best friend with the will and resources to save his life, Evan's first thought was how it all looked. Even having lost everything else, until that moment, he still had a kind of privacy—no one there to see how bad things had really gotten. In order to find him and to get him off the street, Joe had taken away that privacy; that's what it took. What it will take to keep Evan off the street, that's after the break. [ Break ] Brooks: Since pulling Evan off the street a few days ago, Joe has come up with a new plan to save Evan. He's standing at the foot of Evan's hospital bed in San Francisco, delivering his pitch. Wynne: From my perspective, we're in a death-versus-something-else choice, right? I think death is really on the table for you. Between this, between that and your weight loss and your dehydration and just being out there, right, it's really on the table. And I feel like Mexico's the hammer. We swing that hammer (Punches one fist into his other palm.) You are gonna make it to 12 months. Brooks: Joe is punching a fist into his palm and calling Mexico a 'hammer' because what he's proposing is force. Rather than finding his way into residential rehab in San Francisco, which Evan has tried and failed before, Joe is pushing for a more extreme option: Leave this waiting room right now, drive to the airport, and fly to Mexico. Joe found a rehab there called Twilight that does something that no rehab in America can do: Give Joe total control over Evan's life. Mexican law allows families to admit an addicted family member to rehab without their consent. If Evan gives the green light, Joe—and only Joe—can decide how long he stays in rehab. If he tries to leave, he'll be stopped. Wynne: And then after 12 months, you get to show up at my house, 12 months clean, and then we get to work out, eat good, work hard, be around the kids—there's gonna be babies in the house. We're gonna go to lacrosse games. I'm running the business; you can have a job working for me right out the gate. Brooks: While Joe is delivering this rapid-fire vision of their glorious future, Evan is slouched down in his bed. I imagine this is sort of surreal. Forty-eight hours ago, he was on the street, and now he's looking at spending the next year, or two years—it's not up to him—in what is, in essence, a rehab jail. Wynne: You'll be in a very good world as soon as you get outta there, right? And you'd guaranteed get there—you will make 12 months if we send you to Mexico. Brooks: Here was what sounded a lot like a version of recovery that people like Sam Quinones and Susan Eggman are saying people like Evan need. Twilight Recovery Center might give some insight into what works and what doesn't when you approach addiction in this way, and Evan was getting closer to going. Brooks: Twilight Recovery Center is one of a constellation of Mexican rehab centers just south of San Diego catered towards American Sidney is the CEO. Sidney: So in many states in the United States, people can do a conservatorship of people. I wish that they could do a conservatorship on people without going through the legal process but it is an impossibility to complete. Brooks: Do you think about your work as conservatorship? Sidney: Yes, I'm the guardian at the door. I'm the one that makes it happen. Brooks: Recovery centers like Twilight fill a gap in the American system. In the States, as we've heard, the bar for conservatorship is high, and ultimately, the decision around involuntary treatment lies with a judge. At Twilight, all that control falls to Harrison. Sidney: When a family member brings me their loved one, I give them the solution. Ultimately, my signature is gonna release their loved one, whether it's a half an hour from the time that they arrive or a year from now. Brooks: They're handing you a really high degree of trust. Sidney: Correct. That is correct. Brooks: For patients, that can mean a lot of things. If the quality of care is high, that surrender of control can be beneficial. But if it's not, the experience can be nightmarish. In either case, it's a gamble. It can mean a total stranger is in control of your future. Brooks: Was that a hard decision for you to make, to sign away some autonomy? Samantha: I'm not gonna lie: I really didn't know that my parents would have full control over it. Brooks: Samantha—and I'm just gonna use her first name—is a patient at Twilight. She's from Pittsburgh and, by her count, has been to over 30 different rehabs all around the U.S. She told me she didn't really know that this rehab was different until she found out after her first month, which is when she would usually leave. Samantha: That's all I could think about, like, the first month I was here—was going home and getting high. I'm like, I'm so excited to go home and get high. I was just like, Yeah, I'm leaving in, like, a week, and he was like, No, the fuck you're not. (Laughs.) I was like, Okay. Brooks: Four months in, when I spoke with her, Samantha said she was still glad to be there, glad she didn't go home after those first 30 days. Now she still thinks about getting high, but the feeling is fear—that she'll relapse. Samantha: In rehab in the States, when you're in rehab, you can't leave; you can't do anything: You can't have a phone. The nice thing about being here, though, is that we do go out and we do do normal at this place, it's kind of almost a step down from a rehab. Brooks: Oh, that's interesting—like it feels a bit more free, in a way? Samantha: Yeah. Even though you have someone over you, yeah, you feel more free. They give you the idea that you're free, but you're not. Brooks: At first, this struck me as a sort of trick Harrison was playing on patients like Samantha: cultivating this feeling in exchange for compliance. But it's not far from principles you hear from people who advocate for a gentler approach to recovery. The key, they say, is to treat people with dignity. If you create an environment for someone like Samantha or Evan that doesn't feel stigmatized or coercive, even if it is coercive, you might be more likely to recover. [ Music ] Brooks: Back in San Francisco, in Evan's room at the hospital, it's time to make a decision. The hospital's addiction team has come by and thinks they can get him into a long-term residential rehab in San Francisco called Harbor Light. This is one of the best free facilities in the city, one where Evan could stay for up to two years. Joe is pushing hard for Mexico. Evan has tried and failed to stay in rehab in San Francisco before, and Joe's worried that if Evan fails, he won't survive long enough to take another shot. Joe thinks it's time to try something else, but Evan isn't sure. Evan: I don't think I'm ready to do that. I could feel, like, in my head, I'm like, I'm gonna be successful this time. But I still have just, like—I'm still a little worried about having doubt—like, What if I don't, though? And then all that time and money they spent is just wasted again, and it's like … Brooks: Mm-hmm. Evan: I didn't wanna do that. Brooks: Evan, again, will try to get clean in San Francisco. He feels selfish asking Joe to pay for lockdown rehab in Mexico while San Francisco's is free. So instead, Joe, in his salesman way, offers Evan a deal. Wynne: So listen, what I'd like you to agree to—you don't have to agree to it—is if you walk out of this place, the next time I see you, I just want you to get on the fucking plane to Mexico with me. Literally, like, Hey, good to see you; pop a methadone; we get on the plane. 'Cause we almost did that yesterday. You would be in Mexico now. And I get, like, this is the chance for you to do it nice, in a nicer facility, with more freedom, with better Medicare, for no money. I agree that if this works, it's a better deal—if it works. Evan: And it's more, like, if I make it the year, it's like— Wynne: It's more meaningful if you choose— Evan: Yeah. Wynne: —to do it every day than if we force you—if you make the right choice 365 days in a row, it's more meaningful than if you make the choice to get on a plane with me once. How do you feel about, if it doesn't work, the next time I see you, we get on a plane—or you can pull the rip cord whenever. But really, the agreement is, eyeball to eyeball, that I wanna make: If it doesn't work, we're going to Mexico. Thoughts? Any reason to say no? Evan: I don't have any reason to say no. Wynne: All right, so we agree on it? That's your fucking left hand. That's … (Laughs.) All right: Sober or Mexico. Evan: Sober here in SF or Mexican sober jail. Wynne: Uh-huh. Evan: I like it. Brooks: A few hours after this conversation in the hospital, Joe flew back to Washington. Before he left, he gave Evan a phone so we could all stay in touch. A group chat was started, along with Liz, called 'Evan Party Chat,' which left Evan on his own again. In a day or two, it'd be easy enough to walk out, take the bus back to the Mission, and pick up right where he left off: stealing Stanley cups, selling them for fentanyl money. There was nothing keeping Evan at the hospital. A few days later, with the help of the hospital's addiction team, Evan entered a long-term residential treatment program. A month later, a text arrived, saying, 'Hey. Thirty days clean.' At day 72, we get an automated notification saying, 'Evan left the conversation.' A week later, Liz checked to see if he was still there. He was; he just wasn't using his phone. Evan is now past 120 days sober. It's his longest period of sobriety in a very, very long time. [ Music ] Brooks: Back in January—at his inauguration—the mayor spoke about restoring San Francisco's sense of decency and security. About putting a dent in this crisis that was all too visible. To that end, Evan's four months off of the street is a success. The cost of that success is tough to pin down. There were years of effort and care and failure from Liz and Joe. There's the hospital bill, which was probably $10,000 and the cost of housing, feeding, and counseling Evan in residential rehab for up to two years. In San Francisco, the homeless population is somewhere around 8,000. Many are dealing with addiction. Very few have a best friend or a volunteer detective working on their behalf. Something like what it took to get Evan off the street for these four months will be required for thousands of others. [ Music ] Brooks: No Easy Fix is produced and reported by me, Ethan Brooks. Edited by Jocelyn Frank and Hanna Rosin. Engineering by Rob Smierciak. Fact-checking by Sam Fentress. Special thanks to Natalie Brennan and Nancy DeVille. Claudine Ebeid is the executive producer of Atlantic audio, and Andrea Valdez is our managing editor. Radio Atlantic will be back next week.
Atlantic
07-08-2025
- General
- Atlantic
The 48-Hour Fentanyl Clock
At the onset of the AIDS crisis in the early 1980s, U.S. cities began trying new ways to stop the spread of infection among drug users. Ideas that were first seen as radical, such as needle exchanges, quickly caught on—because they worked. San Francisco is one the first places where such programs took root. Now it's one of the places questioning whether they should still exist. This is the second episode in a three-part series from Radio Atlantic, No Easy Fix, about why, even in one of the world's most inventive cities, a visible and pervasive problem is still so hard to overcome. The following is a transcript of the episode: Hanna Rosin: This is Radio Atlantic. I'm Hanna Rosin. Today, we have the second episode of No Easy Fix, our three-part series about why San Francisco, one of the world's most innovative cities, can't seem to solve the very visible problems of homelessness and addiction. Joe Wynne: If there was any series of tasks I could go through to get my best friend back, I would go through hell. Rosin: Last week, we met Evan, who finally made the decision to try and get off the streets. Evan: Yeah, I'm falling apart, and I'm, in a way, I'm kind of glad. (Laughs.) 'Cause I'm—it's kind of making me turn to stop. Rosin: If you missed Episode 1, I highly encourage you to go back and listen. This week, Evan takes his first steps towards recovery—just as the city's mayor starts to implement a less-tolerant approach. Reporter Ethan Brooks takes it from here. Ethan Brooks: Before Evan's life began to look how it does now, before spending all day and all night chasing fentanyl, it looked pretty normal. For a lot of people who are addicted and living on the street, this is not the case; even the idea of a stable life is kind of an abstract thing. But Evan had a good job; he worked for his friend Joe in Northern California. He had an apartment and a family and a dream: of putting his son through college, something Evan's parents weren't able to do for him. Evan: I've always been able to have a job and a house and everything and still have been able to use, and when it got to the point of losing all of that, I was able to make the choice to not use anymore. Brooks: But when fentanyl took hold of him, when he lost the job and the apartment, part of him thought it was only a matter of time before the scale of that loss woke him up, forced him back on the right track. But it seemed to have the opposite effect. Evan: Losing all of that, you would think it would be more of an incentive not to be like this, but it's like the more I lost, the more I got like this. Brooks: Like, if you've lost the job and family and all that stuff? Evan: What is there else to lose, kind of. Brooks: This, usually, is called 'rock bottom.' And the thing about that phrase is that you pretty much only hear it when someone is telling a redemption story, their story of recovery, while so many people who reach this point, who made it all the way down to rock bottom, don't end up telling a story at all. That sense of having nothing left to lose, paired with an addiction to an opioid many times stronger than heroin, is a deadly, deadly combination. But after five years with nothing to live for, Evan did not die. [ Music ] Brooks: One of the reasons Evan survived is because the city of San Francisco marshaled immense resources to keep him—and people like him—alive. The city supplied clean pipes and foil, and clean needles for injection users. In 2022, it provided a place where people could use fentanyl under medical supervision. It gave out Narcan, and trained people to check on drug users if they seemed unresponsive, and to reverse overdoses if they were not. That's done by sliding a plastic nozzle into a stranger's nostril, which is a remarkably intimate act. These measures prevent the spread of disease and bring people back from overdoses that would otherwise be fatal. But in the Tenderloin, and in these pockets of open drug use all around the country, they can also contribute to a sort of limbo—keeping people alive without really living. The idea behind this approach is that what it costs the city might, one day, be worth it if Evan can survive long enough to say something like this: Evan: I don't know where to go. And it's raining, and I'm cold, and I'm hungry (Laughs.) And I'm over it. I'm so over it. Brooks: Those three words, 'I'm over it,' which Evan was clear meant I'm ready to get off the street, ready for treatment ' are supposed to be the magic words. They're supposed to clear a path for Evan to walk out from this liminal existence back into the world of the living. And together with the measures that helped keep Evan alive until he was ready, form a strategy that is more humane and more effective than the alternatives. This is supposed to save Evan's life. That's the theory, anyway. [ Music ] Brooks: From The Atlantic, this is No Easy Fix, Episode 2, 'Tolerance.' The set of strategies that helped keep Evan alive these last few years live under an umbrella of public health philosophy called 'harm reduction.' And immediately, if you start asking around, it becomes clear that no one agrees at all on what harm reduction is. Harm reduction is safe supplies, like clean needles, pipes, and foil, that prevent the spread of disease. It's also Narcan, the overdose-reversal drug. Medications like methadone and buprenorphine that reduce cravings and protect against overdose, that's harm reduction too. Medically supervised injection is also harm reduction. It's even been argued that certain drug dealers, the ones who provide a trustworthy and consistent product, should be called 'harm reductionists.' It's a term with a lot of space for interpretation and, recently, the object of a lot of anger. Brooks: The fate of harm reduction, whatever shape it will take around the country, will dictate when and how thousands of people like Evan seek treatment—and whether or not they live long enough to seek it voluntarily. San Francisco is one the first places in America where this idea took root. Now it's one of the places that will decide its future. Barry Petersen (from CBS San Francisco): 'It appeared a year ago in New York's gay community, then in the gay communities in San Francisco and Los Angeles. Now it's been detected in Haitian refugees; no one knows why. And in heavy drug users, especially in New York City—no one knows why. And in some people with—' Brooks: In the early '80s, HIV was beginning to spread. Across the county, people were dying with conditions that were normally seen in the very elderly or very frail, and no one knew how to help. In New York, about a third of HIV cases were found in IV drug users—that's people injecting heroin or cocaine. San Francisco wasn't yet seeing those types of numbers, but it seemed like only a matter of time before it caught up. In the city, the message for people sharing needles, which was literally handed to people leaving the hospital after an overdose, was: 'Stop doing drugs.' This was, at best, simplistic. Nationally, the message was somehow even simpler; it was the era of the 'Just Say No' campaign. But there was another way, a radical way. Bonnie Fergusson: A lot of people were counseling us that we shouldn't just go out and start a needle exchange, because it was illegal, we'd get in trouble, we'd get arrested—blah, blah, blah. Brooks: This is Bonnie Fergusson, a health researcher living in San Francisco at the time. The idea she's referring to is the photonegative of 'Just Say No'; the idea was free, clean needles. Fergusson: They said we should focus on trying to get a law through the state legislature making it legal first. That's what they wanted us to do. But the problem is, we knew that the virus was not gonna wait until the law changed, so if something effective was gonna be done, it had to be done immediately. Brooks: Bonnie and a few others began an underground needle exchange called Prevention Point. Hilary McQuie: I was invited in because I had friends who were injection-drug users that I was worried about, and also because I have a history of doing nonviolent direct action. Brooks: Hilary McQuie was part of that original group. So was Donny Gann. Donny Gann: The initial idea was that we're gonna do this—it's gonna end up essentially being a civil-disobedience action. Brooks: There were two sides to their plan for an underground needle exchange. One team would distribute needles. They dressed up in ragged clothes to fit in, hid the clean needles and a bucket for the used ones in a stroller, then pushed it around the Tenderloin. That was called the 'roving team.' McQuie: The roving team, we thought, would be the ones that would really be doing the needle exchange. And then the 'sitting-duck team,' as we called ourselves, would be the people who got arrested. Brooks: The point was to get arrested. This was a group of volunteers that wanted to make a statement to force the city to start its own needle exchange. Gann: We designated a time we got together, did a little circle together of, like, Okay, here we go, and— Brooks: (Laughs.) What do you mean, 'a little circle'? Like a huddle? Gann: Sort of hugged (Laughs.) circled up, and, you know, looked at each other, and—I mean, it was, you know, Ethan, it was—I mean, we didn't know what was going to happen. Brooks: The first night, November 2, 1988, they exchanged only a few needles, and only a few more when they went out again a week later. But slowly, word about this underground needle exchange started to spread, and people started lining up. Gann: I always remember it as the third week. We were there at that stationary site and, up at the next corner, appeared two middle-aged, well-developed white men in leather jackets, and they sort of strode down the street towards us. And as they approached, they had their leather jackets unzipped enough that we could read their Police Athletic League T-shirts, which they were both wearing. Brooks: Oh yeah? Gann: They came up, and they said, 'Good evening, citizens,' and we said, 'Good evening,' and they passed by. So then, we were like, 'Well, now they know.' Brooks: Donny, Hilary, and the rest of the sitting-duck team waited to get arrested. But as the weeks passed and the lines at the exchange got longer, it didn't happen. There were no consequences for handing out free needles on the street to drug addicts. On their first night, in November 1988, they exchanged only a few needles. In the spring of 1992, Prevention Point exchanged 343,883 syringes. A study of Prevention Point estimated that in the month of October of 1992, 3,600 syringes contaminated with HIV were removed from the environment by the syringe-exchange program—3,600 contaminated needles in one month. [ Music ] Brooks: What is so extraordinary about Prevention Point and this earliest phase of harm reduction is how undeniably superior it was to 'Just Say No,' not just at saving the lives of drug users, but at preventing the broader spread of HIV and improving the health of the city. It was a program that was, at once, more tolerant and more effective than the status quo. Over the next three decades, what was, at first, a radical approach worked its way from the fringes to the center. President Biden made harm reduction a central pillar of the federal response to the opioid crisis. It became national policy to supply Evan and people like him with free, clean supplies. Thousands of opioid overdoses are reversed by Narcan every year. Harm reduction expanded far beyond syringe exchange. [ Music ] Brooks: In the spring of 2020, just a few weeks into the citywide lockdown, billboards started appearing around San Francisco. One showed a group of young, fashionable people smiling and laughing, looking towards the camera. Keith Humphreys: If you didn't see the text and you just looked at them, you would think, These are probably beer ads. Brooks: This is Keith Humphreys. He's a professor and addiction researcher at Stanford. Humphreys: Because you have attractive young people, they're laughing, they're nicely dressed, they're in a cool apartment, so you think, This must be 'Miller Time' or something like that. Brooks: But the text next to the image says, 'Do it with friends. Use with people and take turns. Try not to use alone.' Humphreys: And then to realize, Oh, this is not (Laughs.) about beer; it's about fentanyl —holy cow, that's unexpected. Brooks: The ads were part of a multistate campaign from the Harm Reduction Coalition. This group was founded in San Francisco in the early '90s, a product of that first needle exchange. For Keith, the billboards clarified something. In the early '80s, HIV was a death sentence, and heroin was the opioid in circulation. By the time that billboard went up in San Francisco, the fundamental equation that had worked so effectively during the AIDS crisis—'make injection-drug use safe to help prevent the spread of HIV'—had undergone a kind of inversion. Humphreys: Heroin use is dangerous, but the odds are, if you use heroin for a year, there's maybe a one-in-a-hundred or a one-in-200 chance that you'll die. Today, thank goodness, we can treat HIV and AIDS, but fentanyl has a death rate annually perhaps as high as one in 20. Now the math has to be different because HIV is a more manageable condition by far, and opioid addiction is a much less manageable condition by far. Brooks: So it followed, for Keith, that what was needed was a new equation for harm reduction. Humphreys: Instead, it evolved much more to a drug-user's-rights point of view, that drug use is a right that should not be infringed, nor should it be looked down upon or stigmatized. The point is that—supporting that person's individual choice to do this, their freedom. It was just an odd politics that I hadn't seen before, because in some ways, people were very prominently identifying with the left for things like anti-racism and anti-policing, but on the other hand, they were evoking a lot of libertarian arguments that are often more common on the right, like around gun rights or the right to refuse to take a vaccine because of the—bodily autonomy should be unlimited. Brooks: Hmm. Humphreys: Whether you think it's right or wrong, that's not a public-health argument. Brooks: Safe supplies didn't cause San Francisco's crisis, but they are by far the most visible of the city-funded harm-reduction services. For a lot of San Franciscans, what they represented was a different kind of tolerance: acceptance of this visible suffering, of decline, and of an uncertain future. [ Music ] (Phone rings.) Daniel Lurie: Ethan, it's Daniel Lurie. Brooks: Daniel Lurie is the mayor of San Francisco. He's been in office now for about seven months. Before that, he ran a nonprofit called Tipping Point Community, which has invested millions of dollars in housing and educational projects. The job in front of Lurie is to pull the city out of the tailspin that started in 2020 with COVID and population decline and the fentanyl crisis. Lurie: We, as a city, just got to this point where we were like, If somebody wants to keep harming themselves and, really, killing themselves, that's their right. And we forgot about the 840—850,000 other people that are raising families here, paying rent, taking their kids to school, and they don't feel safe taking their kids to a bus stop or just walking down the street, because someone is struggling with addiction or is just not well. I think we forgot that for a number of years. I think we lost our way as a city. Brooks: So the mayor's mandate is to find a new way when it comes to unsheltered homelessness and addiction and behavioral health, to redraw the lines around what the city will tolerate and what it will not. Lurie: Having someone out that is lost and hurting and in pain and us saying, 'Oh, we're gonna keep you out there; we're not gonna help you and, actually, we're gonna allow you to do that,' that's not okay. And these are not San Francisco values, to let somebody struggle and use and die on our streets; there's nothing compassionate about that. And so we have to change our approach. Brooks: In these first seven months, the city ended the practice of handing out fentanyl-safe smoking supplies without connection to counseling. The mayor has made plans to increase the number of police officers and sheriff's deputies. He also designated San Francisco as 'recovery first,' meaning its first priority is no longer just survival, but to push people off the street and into recovery. Harm reduction is not being thrown out; clean needles, Narcan, these services aren't going anywhere. But now the idea is to do both. Lurie: I believe in harm reduction. You have to keep people alive to get them into treatment. There's always a sense in our city, and maybe this is in other cities too, that—the competing: that treatment has to fight against harm reduction. I don't see it that way. We have to do both. [ Music ] Brooks: Back in the early days of the needle exchange in San Francisco, the rights and autonomy of drug users were aligned with the interests of public health. The two could coexist, even thrive, under the umbrella of harm reduction. It's the reason those cops didn't arrest Donny Gann on the spot. But the potency of fentanyl requires that cities do more than reduce individual harm. At the very least, they must clear the path to treatment for people like Evan, people who need it. After the break, Evan tries to escape his addiction and life on the street. [ Break ] Brooks: When someone like Evan says they wanna get off fentanyl and get off the street, when they demonstrate that they're serious about that desire, there is a vast machinery that's supposed to jump into gear. In San Francisco, there are more shelter beds and more permanent housing for the homeless per capita than a lot of major cities around the country. It's near the top spenders on both homelessness and addiction per capita. The treatment machine is designed to be fast because when someone like Evan wants change, that window is often vanishingly small. If the city gets it right, Evan can squeeze through and find himself, before long, living a normal life. Recently, the mayor's office has been focusing on the first 48 hours off the street, how essential it is to get people on the right path within that time frame. So let's call this hour one of Evan's 48-hour treatment window. It's 7:30 a.m., Thursday, February 28, 2025—less than two months into the new mayor's administration. (Car door opens.) Brooks: Liz picks me up in the Mission District. Last night, Evan and Liz made a plan to meet at the shelter where he's been staying. There are two things that need to happen before we can check him into residential rehab: First, he needs to get on methadone—that's an addiction treatment that reduces cravings. Second, they need to get medical care for his leg. They don't think rehab will accept him without treating it first. (Street noise.) Liz Breuilly: All right, where's Evan at? Brooks: Hour one does not start well. Breuilly: I talked to him last night, and we were gonna meet here. Brooks: Oh. Breuilly: He was saying he was even gonna sleep out here so I could grab him this morning, but maybe he went inside to get food or something. Brooks: Evan is not inside grabbing food. In hour two and hour three, we learn that he doesn't seem to be grabbing food anywhere else either. Breuilly: Of course the phone's going straight to voicemail. (Car passes.) Breuilly: I can't believe he's not here. Brooks: Around hour six, we try the methadone clinic. Maybe Evan made his way over there on his own. But they won't tell Liz whether he's there or not. Over and over, they say, 'We can't confirm or deny that he's a client,' while Liz begs them for information. Eventually, Liz calls Joe—that's Evan's best friend from before he became homeless. Breuilly: I couldn't find him, and I still can't find him, and now we've missed the window. Wynne: Oh, wait, the fentanyl junkie wasn't good at doing a date and time to make? Whoa. Breuilly: (Laughs.) Wynne: Yeah. [ Music ] Brooks: Only at about hour 12 of Evan's window does Liz learn why she hasn't found him. Archival (KPIX news): Right now on the afternoon edition, police move in and take back a once-tranquil square, then dubbed 'Zombie Park,' in San Francisco, arresting dozens of people for doing and selling drugs. Brooks: Last night, the police raided the park where Evan was. Breuilly: They surrounded the park! They brought in agencies from all over. They had drones flying over, and then they say, Nobody leave the park. Stay in the park. You are under arrest. Brooks: The raid was a sort of statement of intent by the new mayor. He said as much in a press conference afterwards. Lurie (from KPIX news): And this is a message that I want everybody in the city to hear: If you are selling drugs in this city, we are coming after you. Brooks: Have you ever seen anything like that in San Francisco before? Breuilly: Never, never, never, never. Brooks: Evan got away without being arrested. On one hand, the raid was a successful show of force, the type of display many San Franciscans had been hoping for. But on the other, it got in the way of another one of its goals, which was to get Evan off the street. Evan was seeking treatment at a moment, less than two months into the new city government, when the city was beginning to build a new strategy that would use less carrot and more stick. Those first hours of Evan's window went to waste. (Chatter.) The next day is Friday, February 28, hour 26 of Evan's 48-hour window. Liz is back at 9 a.m. this time, with a dozen doughnuts and five coffees. Today, after all the uncertainty and searching the day before, Evan is right where we expect him. Brooks: 'Sup, man? How you doing? Evan: Good. Brooks: Good to see you. Evan: Good. Good to see you too. Brooks: Evan is standing outside the shelter, leaning on someone's wheelchair for support. Liz hands out coffee and doughnuts to people on the street while Evan video-calls Joe. Evan: Oh my goodness. Wynne: Ah, ah, ah, how are you, lover boy? Evan: I'm pretty good. Wynne: You're looking extra humbled right now. Brooks: Evan walks Joe through his efforts to get into treatment on his own, before he linked up with Liz. He says that over the last few weeks, he tried to get into rehab, but was not admitted because of his leg was in such bad shape. He says he got arrested for shoplifting too—and released quickly also because of his leg. Evan's leg is in really bad shape. If he doesn't get medical care for it soon, he risks losing it. It's both the key motivator for Evan to seek treatment and the key obstacle. So far, it's felt like the world has been telling him, We won't treat you, because you're sick. Wynne: Be good, and, yeah, I hope you get it straightened out some, dawg. We'd love to have you up here for a while still and then get you all straightened up, and we'll send you home to your boy. Brooks: When people talk about fentanyl and the threat that it presents, what they focus on, more than anything else, is just how potent it is compared to its predecessors. You'll hear that it's 25 times, 50 times more potent than heroin. Then you hear about overdoses—an epidemic of overdoses, people who overdose two or three times a day. But this singular focus on potency means that we overlook something else, which is time and the way that fentanyl distorts it. On one hand, fentanyl demands a rigid schedule. While a heroin user might get away with a few days without a fix, fentanyl users only have hours before the withdrawal symptoms kick in. To avoid debilitating sickness, Evan uses about four times a day and tries to set aside enough for when he wakes up in the morning. On the other hand, a fentanyl user's experience of time is hazy at best. Almost nobody has a phone or a working watch; these are items that will be stolen immediately in the Tenderloin. Your experience of the passage of time becomes highly inaccurate. And the longer you stay out on the street, the more disconnected from time you become. Evan, for example, didn't know about Trump's reelection until about two weeks after it happened. When his friend Joe mentioned using AI for something, Evan figured Joe was just joking because as far as he knew, AI isn't real. This is why, when someone like Evan is motivated, pace is key. Now that Liz had collected Evan, the clock was ticking. Breuilly: Here, there's parking right here. All right, well, he's gotta go in there. As, we do. Brooks: The first methadone clinic that Evan and Liz try—the same one that, the day before, wouldn't tell Liz whether Evan was there or not—won't take Evan. Apparently, there's a staffing shortage. They give Evan a flyer with information about other methadone clinics in the city, but it's in Spanish. The second methadone clinic says they won't take Evan either. They're not taking any new patients today, and even if they were, Evan would need an ID, which of course Evan doesn't have, because Evan doesn't have anything. But Liz has Evan's ID, a picture of it that she's had for years. She convinces the clinic to make an exception. They take Evan to a back room and start him on methadone. The next step is treatment for Evan's leg, without which Evan won't be admitted to rehab. There's a medical clinic just down the street. It's not a hospital; it's a low-barrier urgent-care facility geared specifically towards people experiencing homelessness. It's a place where injuries like Evan's are a very common sight. Liz and Evan go inside, while I sit in the car, and then, after only a few minutes, they're back. Brooks: They're gonna have you do it yourself? Evan: They couldn't see me today—surprise. Brooks: Why? Evan: 'Cause the wound is too complicated to address at the moment after showing it to them, and they were— Brooks: The medical clinic says they won't treat Evan today. These services that would need to work quickly are instead failing slowly. [ Music ] Brooks: It's now about hour 36 of those first 48 crucial hours, and the sun is going down. On Evan's escape checklist is methadone, which is done, and medical treatment, which has been deferred. Liz will now do Evan's wound care herself. [ GPS gives directions: 'Make a U-turn on Civic Center parking garage. Then turn left on McAllister Street.'] Brooks: Without a proper examination room, Liz and Evan need to find somewhere private. After some debate, they settle on the plaza in front of city hall, in front of the huge, domed building where the mayor and the board of supervisors spend their days. They choose it because the plaza is dark, and Evan is ashamed. Evan steps away to smoke fentanyl before Liz goes to work treating his leg. Fentanyl, at least, is a painkiller. We're not alone in the plaza tonight. The San Francisco Symphony is playing a concert. There's an auditorium packed with people in fancy dress just across the way, listening to Rachmaninoff's Symphony No. 2. By hour 39, Evan's checklist is complete: His leg is clean, with fresh bandages, and he has 50 milligrams of methadone in his system, which will help cut down withdrawals. But it's Friday, and the rehab that Evan and Liz settled on doesn't take new people over the weekend, so Evan will have to make it another 48 hours on his own until Monday. The only answer to the pace that fentanyl sets for people addicted to it is a treatment response at a speed that can match it. Fentanyl users will always fail to get on methadone if intake moves slower than the time it takes to go into withdrawal. They will fail to go to rehab if it takes too long to complete the steps required to get in. And cities will fail to effectively reduce harm if it takes decades to recognize that the tactics that worked for heroin users during the AIDS crisis won't work in the same way for fentanyl users during an overdose crisis. [ Music ] Brooks: In July, Daniel Lurie signed his first budget as mayor. The budget increased money for shelter beds and treatment beds for people dealing with addiction, and reduced spending on permanent supportive housing and harm-reduction programs. Brooks: The next day, I'm sitting with Evan while he talks to Liz on the phone. It's hour 56 of Evan's 48-hour window. Breuilly: Yeah, you guys wore me out a little bit. I'm, you know, I know I look amazing, but I'm not 20. Evan: (Laughs.) Brooks: Liz has been thinking about what she saw last night when she changed Evan's dressing, and you can hear that she's worried. Evan is worried, too. Breuilly: Your leg is not gonna look drastically better anytime soon. Evan: (Laughs.) Right. Breuilly: Right? So you have what we call now a 'chronic leg wound.' Evan: Right, right. Like John— Brooks: From last night to today, Liz decided she wants to throw out the original plan. Quit the treatment infrastructure; enter the emergency-medical system. Now she wants Evan to go to the hospital, to San Francisco General, as soon as they get off the phone. Breuilly: Okay, so go back to SF General—take a breath. I'm proud of you. This is a lot, okay? I'm sorry, buddy. I'm sorry. Now, go back to the General. Tell them, when you check in, just the truth: that you've had increased swelling, increased pain, and the wound is a lot worse; that you are trying to get into treatment and that they will not take you, currently, with no wound-care plan for your leg; and that you're very— Brooks: Liz and Evan wrap up their call. Evan and I stand at 16th and Mission as the day turns into night, and we keep standing, keep talking. I'm flying out soon, so I set up an email account for Evan so he can stay in touch from the hospital and write down my phone number on pieces of paper so he can call me when he arrives at the hospital. Evan pulls out deodorant and Q-tips—from where, I don't know—cleans himself up to get ready. He says he'll call me when he arrives. [ Music ] Brooks: That call never comes. We have missed the crucial window, and now, in urgent need of medical care, Evan is gone. [ Music ] Next week: San Francisco takes its first steps toward expanding a system that would force people like Evan off the street and into care. And Joe and Liz search for their missing friend. [ Music ] No Easy Fix is produced and reported by me, Ethan Brooks, edited by Jocelyn Frank and Hanna Rosin. Engineering by Rob Smierciak, fact-checking by Sam Fentress. Claudine Ebeid is the executive producer of Atlantic audio, and Andrea Valdez is our managing editor. See you next week.
Yahoo
31-07-2025
- Politics
- Yahoo
Can San Francisco Be Saved?
The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here. Subscribe here: Apple Podcasts | Spotify | YouTube | Overcast | Pocket Casts A week ago, President Donald Trump signed an executive order called 'Ending Crime and Disorder on America's Streets.' The order states that 'vagrancy' and 'violent attacks have made our cities unsafe' and encourages the expanded use of institutionalization. The order comes at a crucial moment for many American cities that have tried—and often failed—to meaningfully address homelessness and addiction. In 2024, the number of people experiencing homelessness on a single night was 771,480, the highest number ever recorded in the United States. In recent years, San Francisco has become emblematic of the crisis. And now a new mayor has pledged to prioritize the problem. To understand what's at stake, I got to know one man who has been living on the street and struggling with addiction—and who says he is finally ready to make a change. This is the first episode of a new three-part miniseries from Radio Atlantic, No Easy Fix, about what it takes to escape one's demons. The following is a transcript of the episode: Hanna Rosin: A week ago, President Trump signed an executive order called 'Ending Crime and Disorder on America's Streets.' Now, this order could be read as Trump setting up another showdown between his administration and liberal cities. But actually, some cities are already ahead of him on this. I'm Hanna Rosin. This is Radio Atlantic. Over the next three weeks, we're bringing you a special series about the beginnings of an experiment. A lot of American cities already know they have a real problem: a few streets or a neighborhood where the social order seems to have completely broken down. They're crowded with people living on the streets, often with addiction. And even before this executive order was signed, some cities were beginning to take these places on—or at least audition some new ways to fix the problem. Reporter Ethan Brooks looks at San Francisco, which is an obvious place to look because it's a city known for being exceptional at thinking up solutions to all kinds of complicated problems. Why hasn't it been able to crack this one? Ethan finds some answers close to the ground. He follows one guy and gets some insights about why the solution these cities are looking for is so elusive. Evan: I know some people that will spend hours and hours and hours and hours just holding up a cardboard sign in an intersection. It might take him 10 hours to make $10. Ethan Brooks: And you won't do that? Evan: I just—fuck. It's just knowing I could do that, or I could spend 15 minutes inside of a store, 10 minutes inside of a store, five minutes inside of a store sometimes, and then make enough money. Brooks: There are a lot of ways you could describe Evan. But if we're really getting down to it, a title that fits pretty well is 'thief.' Over the last six years or so, Evan has dedicated many of his waking hours to stealing. On a typical day, Evan—and I'm just going to use his first name to protect his privacy—Evan takes the train out of town from where he lives, in San Francisco, shoplifts all day, then comes back home. Sometimes he calls this his 'job' or 'going to work.' When he sleeps, it's out on the street or in a shelter. In Evan's world, what he does is called being an 'out-of-town booster,' as in someone who boosts, or steals, property from outside of San Francisco— which, in his circle, affords him a certain amount of status: one rung higher on the ladder than an in-town booster. Evan: The in-town booster isn't making real money. You're making, like, 20, 40 bucks a run. Brooks: Okay. Evan: But out-of-town boosters, somebody's gonna be gone all day, going to a couple different stores and then coming back, making several hundred bucks. Brooks: Evan steals so that he can sell. He's had success converting Frappuccinos, Nutella, honey into cash. Tide Pods, apparently, are always in high demand. Lately, he's been boosting Stanley cups from the Target in Emeryville, just north of Oakland. [] Brooks: He then takes the train to the Civic Center in San Francisco to sell to a middleman, who will sell the stolen Stanley cups to a diverter, who will repackage them and resell them on eBay. Evan is part of an economy that sells millions and millions of dollars of stolen goods every year. Recently, this particular Target has been on Evan's mind because he just cannot believe how easy it was to steal from them. Evan: I literally went, like, 27 days in a row because I kept telling myself, If it doesn't work, I'll quit fentanyl. And it just kept working, and it kept working, and it kept working every day. And I was like, What is going—this is, like, a Groundhog's Day or something. Brooks: Another title you could give Evan, apart from thief, is 'addict.' Fentanyl is the singular driving force behind his shoplifting. In the eyes of the middlemen who resell what he steals, fentanyl makes Evan the ideal employee: highly motivated, with a huge tolerance for risk and nothing to lose. In the real world, Evan is just a normal guy, a mechanic, and from what I'm told, a good one. But in San Francisco, as one of Evan's oldest friends put it to me, he is the 'King of the Fools.' Evan: It didn't really feel like that until I got to San Francisco. Brooks: Uh-huh. Evan: Everywhere else was super hard to make it, I feel like. Well, of course when I was there I didn't really think that. Um, but When I got here, it was so much easier. Ow. Brooks: You all right? Evan: Yeah, my leg. Can you help me put this back just a little bit again? (Laughs.) I'm sorry. Brooks: For sure. No problem, dude. Brooks: Evan pauses our interview here and asks me to adjust his hospital bed. Brooks: Like here, or all the way further down? Evan: A little bit more. Right, that's perfect. Brooks: We're sitting in Evan's room in San Francisco General Hospital. Evan is propped up in bed wearing a paper gown, with an IV drip taped to his arm. There is a huge pile of candy next to his pillow: sour worms and Starburst and Twix that hospital staff gave him. Addicts often get really intense sugar cravings. This happens for a lot of reasons, but in the end, a sugar high is still a kind of high. At the moment we're talking, Evan is in a bad way. He is visibly emaciated—with knobby elbows, rib cage on full display—and he's struggling to control his body. Depending on what happens next, death, he thinks, is a real possibility. I met Evan just a few months ago, about six weeks before this conversation in the hospital, and have followed along with him as he has made this journey from being an out-of-town booster, the 'King of the Fools,' to where he is now. Evan: We were watching this show last night about Vikings, and apparently, it was Viking tradition that when men or women would get older and they couldn't hunt, fish, or farm or help get anything, that they would just go jump off a cliff and kill themselves 'cause they were a burden to their family. Brooks: Mm-hmm. Evan: And so I thought about that. But that's the position I would be in if I was like, if that was back, you know, if it was the time we were in now. They'd be like, You can't even help us do anything 'cause your leg is fucked up, and you can't even eat a whole meal without vomiting, so we're just gonna take you to the Valhalla cliffs or whatever and have you jump. Oh man. [] Brooks: Like Evan says, there are these places around Scandinavia where, supposedly, in early Norse society, the elderly and infirm leapt to their deaths when they had no more purpose to serve. In the TV show Evan watched, there's a shot of a man leaping off this huge, towering cliff and simply falling out of the frame. He disappears. But the thing about this Viking tradition is that it's just a story; it's a myth. The cliffs are real enough, but there's no evidence anyone ever jumped off them. The Vikings had to figure out a way to care for these people, just like the rest of us. [] Brooks: The weeks I spent following Evan, a period that ended with him in this hospital bed, were critical weeks for him. It was also a critical period for San Francisco, when the city began to change its approach to people like Evan, people who are in need of real care and whose presence threatens the health of the city. From The Atlantic, this is No Easy Fix Episode 1, 'The Vanishing Point.' [] Brooks: Back in the first years of the pandemic, a new type of video started showing up on YouTube and other corners of social media. Tyler Oliveira: This is San Francisco—the city that pays drug addicts to use drugs? Brooks: They had titles like 'I Investigated the City of Real Life Zombies' and 'I Investigated the City Where Every Drug Is Legal.' Oliveira: Rampant homelessness, deadly drug addiction, and unpunished shoplifting and car break-ins. Businesses are fleeing, and the city is dying. But how did it get to— Brooks: What they were showing, to audiences of millions and millions of people, were these places in American cities where it felt like the social order had broken down completely. City blocks and encampments crowded with people injecting, overdosing, and dying—all right out in the open. Oliveira: —the center of America's drug epidemic, overrun with a drug known as 'tranq,' a mixture of horse tranquilizer and fentanyl that's turning people there into real-life zombies. Brooks: It wasn't just San Francisco in the spotlight. There was Kensington Avenue in Philadelphia, Skid Row in Downtown L.A., encampments underneath I-5 in Seattle, the storm drains under the Las Vegas Strip. There were, and still are, livestreams of these places broadcasting these images 24/7. [] Brooks: The videos gave these places a new notoriety. And it was San Francisco—specifically, the Tenderloin neighborhood—that was maybe the most infamous. There was the reality of the thing, and I'll just give one stat here to illustrate this: In this period, nearly twice as many people died of overdose in San Francisco than died of COVID-19. Fentanyl killed far more people than the pandemic. Then there was this contrast that wasn't quite the same as anywhere else: needles and human waste covering the sidewalk, signs of the most self-destructive, destitute humanity, in the same city at the cutting edge of this new technology that can write and speak like a human. Joe Wynne: From the outside, it's, like, this really grotesque cesspool, but once you're in there, it's a bizarrely normal social situation. Joe Wynne has spent a fair amount of time among people dealing with addiction in the Tenderloin, not because he's lived there himself, but because he is Evan's best friend—from before Evan got wrapped up in fentanyl. Brooks: Do you remember the first time you met Evan? Wynne: Yeah, he was a mechanic at this high-end, custom 4x4r shop in North Carolina. Brooks: Before living on the streets in San Francisco, Evan worked as a mechanic in North Carolina. The shop he worked for is a sort of Pimp My Ride for wealthy, crunchy digital nomads looking to live the van life for a while. Joe is not a digital nomad, but he's wealthy enough and at least a little crunchy. So back then, he enlisted Evan and the shop where he worked to outfit his camper van. At the time—this was around 2013—Joe was traveling and living out of his van and, with it in the shop, didn't have a place to live. Wynne: And Evan was like, You can sleep in my basement. And after, like, half a day there, they're like, Oh, you can move into the guest bedroom; it's totally available. You're not a crazy person. Brooks: So Joe and Evan became friends not so long ago because Evan offered Joe a place to stay. And they had a lot in common: They both love cars, they both became fathers when they were quite young, and they're both relentlessly outgoing. Wynne: He's one of the most charming people I've ever met. If you leave him alone in a group of four or five strangers, he will be best friends with everybody inside of 30 minutes. He's absolutely a life-of-the-party kind of guy and not in the big, loud, over-the-top way, in the kind of goes around and has a really great conversation with everyone where they feel like the center of the room. That's really his superpower, is, I feel like, is that type of little conversational loop with people. Brooks: When Joe's van was finished, they went their separate ways. Eventually, Joe went on to start a cannabis company in Northern California; Evan stayed in North Carolina. But they stayed in touch, got to know each other more, and Joe started noticing another side of Evan too. Wynne: There's, like, two sides: There's Evan and Melvin. Melvin is malicious Evan, or, like, the evil side inside of him that completely takes over, but I almost never see it. I see the aftermath of it, but he never lets me see full-blown. Brooks: If there were drugs around, Evan would do as much as he could. To Joe, it felt like he didn't understand how a sacrifice in the present might be beneficial in the future. [] Despite the lurking threat of Melvin, around 2016, Joe convinced Evan to move out to California to work for him at his cannabis company. They manufactured the oils in THC pens. Evan managed a team; Joe considered him his right-hand man. Joe had a strict 'no hard drugs' policy for his employees, and one day, Evan slipped. Wynne: So I had a drug-test kit on-site, so I told him, I said, Hey, we're going out back, and let's go piss in a cup. And he was like, Oh, oh, oh—you know, he started to freak out. And I tested him, and it was the thickest blue line for positive opiates ever, so I took him back to his room, and we loaded up everything he owned, and I said, I just can't carry you if you're gonna do that. It was excruciating, man; it was bad, and I knew it was gonna go worse. But I just couldn't have it go worse in my living room. I had a lot of people who were counting on us to make good decisions to feed their families. And it was one of the toughest days ever in my business career 'cause he was absolutely my best friend, and I felt like, that day, I felt like it was like signing his death warrant. Brooks: Once he separated from Joe, it didn't take Evan too long to make his way down to San Francisco. When Evan discovered that he could shoplift and sell what he stole and buy fentanyl all in the same place, he never left. That economy, the ease with which he could support his habit, is what kept him there. Joe went on to sell his company for a lot of money. He told me that after the sale, many of his employees got bonuses big enough for a down payment on a house. Evan, meanwhile, stole Tide Pods and slept on the street. Wynne: I would fight anything to change it. If there was any series of tasks I could go through to get my best friend back—even if I didn't get him back, even if he just got his life back—I would go through hell, 'cause like Evan, I love a challenging, knives-and-daggers, bleeding-in-the-streets fight for something that's worth it. And for my best friend who helped me—I'm living my dream life right now: I live in my dream home with the greatest partner I could ever have. My kid goes to a wonderful school and is blossoming. The car that me and Evan always talked about—the insanity car, the insane race car—it's in the garage, right? Brooks: (Laughs.) Wynne: And I've completed all life dreams, and I'm having to literally spend time making up new ones. I would do anything to help him get back his portion of the dream 'cause he helped me get mine. Brooks: Over the years, Joe has tried to give Evan back his portion of that dream. One time, he tracked Evan down in the Tenderloin, rented a penthouse suite for them both, with a Jacuzzi tub. I've seen the pictures of Evan looking like a wet dog in a tub he has single-handedly turned absolutely filthy. Joe tried, simply, to return that favor that Evan offered him when they met: a place to live. Wynne: I was just like, Hey, and I talked to him about it, and I said, Hey, I'm living alone on this land up north. The wife has not moved in. I was like, You could move in and go through horrific withdrawal and be a total piece of shit, and nobody would know except me. You can hang out. I'll put you on salary. You'll make a little money— Brooks: Yeah. Wynne: And he was like, he just literally said it: He's like, Yeah, I'm not done yet. (Laughs.) I'm not finished— Brooks: Not done yet? Wynne: Yeah. I'm not—I don't think I'm done yet. [] Brooks: Evan is just one of over 4,000 unsheltered people living in San Francisco. 'Unsheltered,' by this count, means living on the street, bus stations, parks, tents, and abandoned buildings. There are around 4,000 more in temporary shelters. Nationally, those numbers are even more grim. In 2024, the number of people experiencing homelessness on a single night was 771,480, the highest number ever recorded in the United States. To be very clear, 'I'm not done yet' is by no means a representative attitude of that whole. Unsheltered life is grueling—sometimes violent, and often deadly. Evan's willingness to leave that behind, or not, doesn't change that fact. There are many reasons why so many people in America are homeless, first among them being a lack of homes. It's no coincidence that things are so rough in one of the most expensive cities in America, while in places like West Virginia, which has its own opioid crisis and much cheaper housing, unsheltered homelessness is much more rare. [] Brooks: This year, San Francisco elected a new mayor, Daniel Lurie, an ultra-wealthy moderate in a city famous for its progressive politics. Daniel Lurie: Today marks the beginning of a new era of accountability and change at city hall, one that, above all else, serves you, the people of San Francisco. Brooks: The new mayor has his work cut out for him. San Francisco has become emblematic of what sometimes gets called a 'doom loop,' something that has happened in a lot of cities since the pandemic. In this loop, the office buildings empty out because of the pandemic and remote work. The stores and restaurants that served office workers are forced to shutter. Crime soars. Tax revenues fall. Public transportation is forced to cut back, so even fewer people come downtown. And on and on and on. Lurie is not a tough-on-crime mayor. He's not gutting the city's addiction and homelessness services. But the way he spoke about these problems, which was the first topic in his inauguration speech, was different. Lurie: I entered this mayor's race not as a politician, but as a dad who couldn't explain to my kids what they were seeing on our streets. Brooks: Lurie talks about what he could see—what the problem looks like, the effect of this constant onslaught of imagery on individual well-being. Lurie: Widespread drug dealing, public drug use, and constantly seeing people in crisis has robbed us of our sense of decency and security. Now, safety isn't just a statistic; it's a feeling you hold when you're walking down the street. That insecurity is— Brooks: One reason he might be using these terms is that, by the numbers, the unsheltered, visible homeless population in San Francisco is nearly the same as it was 10 years ago. What has changed is everyone else. It's hard to get exact numbers, but downtown San Francisco has lost about two-thirds of its daytime population—that's hundreds of thousands of commuters and office workers gone, which leaves just Evan and people like him. This, in short, might be called a visibility problem. People feel scared and maybe a little ashamed having to see so many people experiencing homelessness every day,which is an odd problem because for many people living on the street, a family member, or a loved one, is looking for them. [] Brooks: Visible to a city that sees too much of them. invisible to families who would love nothing more than to see them. That's after the break. [] Brooks: In late February, about six weeks before Evan would find himself in the hospital, I met Liz Breuilly. Liz is in her 40s and lives in the mountains outside of San Francisco. She lives a sort of double life. Her day job is in the medical field, and in her spare time, she does something else. Liz Breuilly: I'm not a private investigator. Nobody's paying me and nobody's licensing me to do the work that I do. Brooks: How would you describe what you do? Breuilly: (Laughs.) I feel like I started doing one thing, right, in the beginning, several years ago, and I feel like it's evolved into many different things. Brooks: Mm-hmm. Breuilly: Primarily, I would say that I locate missing persons that are either mentally ill, drug-addicted, and/or experiencing homelessness. Brooks: Liz finds missing people. She does this for free. I've asked her probably 25 times why she does this, and even to her, it's not clear. [] What is clear is that there's plenty of finding to do. There are around 1,400 people on the San Francisco Police Department's missing-persons list. And given that 'missing' just means that someone somewhere is looking for you—and has filed a police report—that number could be much higher. [] Brooks: Liz and others who spend time in the Tenderloin and encampments think that many of these people are here—which is strange, considering all of these disappeared people are far more visible than those of us spending our days in cars and offices, our nights in houses and apartments and bedrooms, while they're out on the street, exposed. In these first couple months of the new mayoral administration, the city has been experimenting with new solutions to this problem of unsheltered homelessness and open drug use. There have been mass arrests of dealers and users, pushing the jail population to levels that haven't been seen in years. One corner of the Tenderloin was turned into a triage center, which has since shut down, where people could go for coffee, to be connected with city services, and be offered a free bus ticket out of town, courtesy of the city. But there's no city program that does what Liz does. She's a sort of one-woman case study of a different approach, a radical approach, to this problem: reconnect lost people with their families and see if things change. Breuilly: Most of the time, when families get to me, they think their loved one is deceased. And so they're almost just looking for validation that that's the case, and it's usually not. I have located, I don't know, well over 200 people, maybe 2—I don't even know. It's been well over 200. Brooks: Evan was once one of Liz's lost people. Brooks: Do you remember who reached out to you about him the first time? Breuilly: Mm-hmm, yeah, his sister did. His sister did. He had been missing for several years, and she basically was, you know, said, This is my brother, and I heard what you do, and I'm wondering if you would help me. And I said, Sure. Brooks: There's no big secret to how Liz works. She asks families about their missing person, about their history of addiction and mental illness. She checks arrest records. She's in frequent contact with the city morgue. But mostly, she just adds pictures, like Evan's picture, to a folder in her phone, memorizes faces as best she can, and starts looking. And then, one day, there Evan was. Breuilly: So I roll down the window, and I scream, 'Evan! Evan!' (Laughs.) And he stopped, and he looked at me, and he ... (Laughs.) He basically was like, I don't know you. And I'm shouting at him from my car, and I said, No, you don't know me. I just need to talk to you for a second. And that's what started a, I don't know, four-year friendship, right, with him. Brooks: Did Evan call his sister when you— Breuilly: No. Brooks: —caught up with him? No? Breuilly: No, he did not. He just couldn't do it. Brooks: A lot of people who Liz finds don't call their families. Many of them do call but don't leave the street or go home. One person I met through Liz put it this way: 'I don't want to be missing, and I don't want to be found either.' So this limbo—not missing, not found—is where many of Liz's people stay for years. Breuilly: Every time they hear about someone overdosing or every time someone posts a video of a sheet over somebody, I'm getting a phone call from five parents asking me if I know who it is and if that's their kid. Brooks: Liz and I are driving around downtown San Francisco. A lot of open drug use and encampments that were concentrated in the Tenderloin are now more diffuse. In the Mission District, the alley behind the Everlane is packed with people smoking, injecting, laid out. Once in a while, a cleanup crew drives through, clears everyone out, hoses the alley down, and then everyone comes back. Breuilly: People were never spread out like this. I mean, there would be, in certain areas, I mean, at nighttime, there'd be 250, 300 people. And at nighttime, it still gets like that when the cops run around, but because the cops are really doing a lot of work with patrolling and doing all this stuff, it breaks them up. Brooks: Today, Liz has been looking for one guy in particular. A few weeks ago, he had asked her to find his mom, and Liz learned pretty quickly that his mom had passed away. Breuilly: So—but I also know that if I don't tell him, no one else will. Brooks: Yeah, 'cause nobody even knows, right? Breuilly: Yeah, and the only way to reach him is to do what we're doing today, which is going back out on the street to find him. Brooks: Late in the afternoon, she sees the guy she's looking for. Breuilly: I think that's him. I think that's the guy. Brooks: The man is wearing a red flannel and a corduroy jacket, with a set of neon ski goggles around his neck. He's half-standing out of his wheelchair, leaning over a row of trash cans, digging through the garbage and throwing things aside. Here's what will happen next: Liz will tell him the news—that his mother has passed away. He will cry and thank Liz for telling him. They'll smoke cigarettes together, even though Liz doesn't smoke cigarettes, for 10 minutes and then 20 minutes as he tries to adjust to this new reality. But before any of this can happen, there's a problem: The street we've pulled over in is narrow and behind us, suddenly, is a white Jaguar SUV with no one in the driver's seat. A self-driving car is stuck behind us, with traffic backing up behind it, preventing this volunteer bearer of the worst possible news from doing her job. Breuilly: Well, it's definitely a feeling of helplessness, right? This kid is very, very sick. Yes, am I glad I was able to give him the information and hopefully set him free a little bit from this persistent state of looking? But in the same respect, it's like I'm leaving somebody a little bit worse than in the situation they were in. And so it's deflating because, even me, who is really—I know the resources in the city. But right now, there's nowhere to take no space in shelters. He doesn't have a phone. I can't bring him home to my house. What am I gonna do? [] Brooks: It's not just San Francisco trying to ram a metaphorical self-driving car through a metaphorical alley of grief. Cities around the country are desperate to move on. Portland, Oregon, elected a new mayor who pledged to end unsheltered homelessness, after the state re-criminalized drug possession, after decriminalizing in 2021. Philadelphia, Pennsylvania, elected a tough-on-crime mayor, and hired more police. Fremont, California, criminalized not just homeless encampments but 'aiding' and 'abetting' homeless encampments in any way. Everyone, from city leadership to regular people like Liz, seem desperate to move on and willing to try new things. Liz, in part, does this work because no one else will. Brooks: It's night now, and Liz is still out looking for a few missing people. And, tucked up behind the passenger-side visor in her car, Liz has a bundle of printed-out emails from Evan's family and a picture of his kid, a middle schooler now, playing the clarinet. At night, the plaza at 16th and Mission turns into a packed open-air market of stolen goods. The sellers, mostly are addicts, are hawking used clothes, kids' toys, tamales, phone chargers, a tricycle, and remarkably, tonight, an enormous slab of bacon. The shoppers are mostly low-income San Franciscans chasing a good deal. Behind them are the dealers, many of them young Honduran men in masks. Hundreds of people are walking around this dark patch of concrete. Cash moves in one direction: from the buyers to the sellers to the dealers. Standing on one corner, leaning against a street sign, is Evan. Evan: Every time, every time—like, the last, what, like, five times, it seems like—I've been like, I really need to see Liz today. I need to see Liz. Today, I literally kept thinking today— (Dog barks.) Evan: —I was like, I need to find her. I need to find her. Breuilly: Here I am. Brooks: This is the first time I met Evan, weeks before our conversation in the hospital. Evan is looking shaggy, but in relatively good health. And he swears that when he needs Liz, he can manifest her. Breuilly: How are you, though? Why did you manifest me? Evan: Because I'm, I have to figure something out. Breuilly: Okay, what've you got going? Brooks: Evan tells Liz that he hasn't been able to keep much food down for weeks. And his legs are infected and extremely swollen. Leg infections are common for fentanyl users like Evan due to contaminants in the supply and side effects from injection. It's why you see so many people in wheelchairs. Breuilly: How is it? Ooh, it … (Gasps.) Evan: Yeah— Breuilly: Evan! Evan: I know, that's what I'm saying. So I need, I need some, I need, I'm—I, with my leg and my stomach, I was like, I'm over this. Breuilly: Oh, wow. Evan: I'm so over it. I'm so over it. And I'm, like, I'm just ready— Breuilly: Pitiful. Evan: —for something to change, something— Breuilly: Yay! Evan: (Laughs.) Brooks: Liz, as Evan is speaking, is beaming. This was a full 180 from the 'I'm not done yet' Evan told Joe when he tried to get him off the street a few years ago. This was the first time in the years Evan and Liz have known each other that Evan has said he wanted to get off the street and get off fentanyl. Evan: Yeah, I'm falling apart, and I'm, in a way, I'm kind of glad. (Laughs.) 'Cause I'm—it's kind of making me turn to stop. Brooks: Yeah. [] Brooks: It might not sound like much, but when someone like Evan, who has been addicted to opioids for many, many years, says, 'I'm ready,' this is the moment that San Francisco's, and many cities', strategy to address this problem is built on. So here we were: Evan is ready to get off the street; the city of San Francisco is eager to help. Evan's readiness is supposed to trigger action—a chance to put a dent in this visible suffering that haunts the mayor and so many other San Franciscans. Plus, Evan's got Liz, who has a car and a phone. How hard could it be? That's next week. [] No Easy Fix is produced and reported by me, Ethan Brooks. Editing by Jocelyn Frank and Hanna Rosin. Engineering by Rob Smierciak. Fact-checking by Sam Fentress. Claudine Ebeid is the executive producer of Atlantic audio. Andrea Valdez is our managing editor. See you next week. Article originally published at The Atlantic Solve the daily Crossword
Atlantic
31-07-2025
- Politics
- Atlantic
Can San Francisco Be Saved?
A week ago, President Donald Trump signed an executive order called 'Ending Crime and Disorder on America's Streets.' The order states that 'vagrancy' and 'violent attacks have made our cities unsafe' and encourages the expanded use of institutionalization. The order comes at a crucial moment for many American cities that have tried—and often failed—to meaningfully address homelessness and addiction. In 2024, the number of people experiencing homelessness on a single night was 771,480, the highest number ever recorded in the United States. In recent years, San Francisco has become emblematic of the crisis. And now a new mayor has pledged to prioritize the problem. To understand what's at stake, I got to know one man who has been living on the street and struggling with addiction—and who says he is finally ready to make a change. This is the first episode of a new three-part miniseries from Radio Atlantic, No Easy Fix, about what it takes to escape one's demons. The following is a transcript of the episode: Hanna Rosin: A week ago, President Trump signed an executive order called 'Ending Crime and Disorder on America's Streets.' Now, this order could be read as Trump setting up another showdown between his administration and liberal cities. But actually, some cities are already ahead of him on this. I'm Hanna Rosin. This is Radio Atlantic. Over the next three weeks, we're bringing you a special series about the beginnings of an experiment. A lot of American cities already know they have a real problem: a few streets or a neighborhood where the social order seems to have completely broken down. They're crowded with people living on the streets, often with addiction. And even before this executive order was signed, some cities were beginning to take these places on—or at least audition some new ways to fix the problem. Reporter Ethan Brooks looks at San Francisco, which is an obvious place to look because it's a city known for being exceptional at thinking up solutions to all kinds of complicated problems. Why hasn't it been able to crack this one? Ethan finds some answers close to the ground. He follows one guy and gets some insights about why the solution these cities are looking for is so elusive. Evan: I know some people that will spend hours and hours and hours and hours just holding up a cardboard sign in an intersection. It might take him 10 hours to make $10. Ethan Brooks: And you won't do that? Evan: I just— fuck. It's just knowing I could do that, or I could spend 15 minutes inside of a store, 10 minutes inside of a store, five minutes inside of a store sometimes, and then make enough money. Brooks: There are a lot of ways you could describe Evan. But if we're really getting down to it, a title that fits pretty well is 'thief.' Over the last six years or so, Evan has dedicated many of his waking hours to stealing. On a typical day, Evan—and I'm just going to use his first name to protect his privacy—Evan takes the train out of town from where he lives, in San Francisco, shoplifts all day, then comes back home. Sometimes he calls this his 'job' or 'going to work.' When he sleeps, it's out on the street or in a shelter. In Evan's world, what he does is called being an 'out-of-town booster,' as in someone who boosts, or steals, property from outside of San Francisco— which, in his circle, affords him a certain amount of status: one rung higher on the ladder than an in-town booster. Evan: The in-town booster isn't making real money. You're making, like, 20, 40 bucks a run. Brooks: Okay. Evan: But out-of-town boosters, somebody's gonna be gone all day, going to a couple different stores and then coming back, making several hundred bucks. Brooks: Evan steals so that he can sell. He's had success converting Frappuccinos, Nutella, honey into cash. Tide Pods, apparently, are always in high demand. Lately, he's been boosting Stanley cups from the Target in Emeryville, just north of Oakland. [ Music ] Brooks: He then takes the train to the Civic Center in San Francisco to sell to a middleman, who will sell the stolen Stanley cups to a diverter, who will repackage them and resell them on eBay. Evan is part of an economy that sells millions and millions of dollars of stolen goods every year. Recently, this particular Target has been on Evan's mind because he just cannot believe how easy it was to steal from them. Evan: I literally went, like, 27 days in a row because I kept telling myself, If it doesn't work, I'll quit fentanyl. And it just kept working, and it kept working, and it kept working every day. And I was like, What is going—this is, like, a Groundhog's Day or something. Brooks: Another title you could give Evan, apart from thief, is 'addict.' Fentanyl is the singular driving force behind his shoplifting. In the eyes of the middlemen who resell what he steals, fentanyl makes Evan the ideal employee: highly motivated, with a huge tolerance for risk and nothing to lose. In the real world, Evan is just a normal guy, a mechanic, and from what I'm told, a good one. But in San Francisco, as one of Evan's oldest friends put it to me, he is the 'King of the Fools.' Evan: It didn't really feel like that until I got to San Francisco. Brooks: Uh-huh. Evan: Everywhere else was super hard to make it, I feel like. Well, of course when I was there I didn't really think that. Um, but When I got here, it was so much easier. Ow. Brooks: You all right? Evan: Yeah, my leg. Can you help me put this back just a little bit again? (Laughs.) I'm sorry. Brooks: For sure. No problem, dude. Brooks: Evan pauses our interview here and asks me to adjust his hospital bed. Brooks: Like here, or all the way further down? Evan: A little bit more. Right, that's perfect. Brooks: We're sitting in Evan's room in San Francisco General Hospital. Evan is propped up in bed wearing a paper gown, with an IV drip taped to his arm. There is a huge pile of candy next to his pillow: sour worms and Starburst and Twix that hospital staff gave him. Addicts often get really intense sugar cravings. This happens for a lot of reasons, but in the end, a sugar high is still a kind of high. At the moment we're talking, Evan is in a bad way. He is visibly emaciated—with knobby elbows, rib cage on full display—and he's struggling to control his body. Depending on what happens next, death, he thinks, is a real possibility. I met Evan just a few months ago, about six weeks before this conversation in the hospital, and have followed along with him as he has made this journey from being an out-of-town booster, the 'King of the Fools,' to where he is now. Evan: We were watching this show last night about Vikings, and apparently, it was Viking tradition that when men or women would get older and they couldn't hunt, fish, or farm or help get anything, that they would just go jump off a cliff and kill themselves 'cause they were a burden to their family. Brooks: Mm-hmm. Evan: And so I thought about that. But that's the position I would be in if I was like, if that was back, you know, if it was the time we were in now. They'd be like, You can't even help us do anything 'cause your leg is fucked up, and you can't even eat a whole meal without vomiting, so we're just gonna take you to the Valhalla cliffs or whatever and have you jump. Oh man. [ Music ] Brooks: Like Evan says, there are these places around Scandinavia where, supposedly, in early Norse society, the elderly and infirm leapt to their deaths when they had no more purpose to serve. In the TV show Evan watched, there's a shot of a man leaping off this huge, towering cliff and simply falling out of the frame. He disappears. But the thing about this Viking tradition is that it's just a story; it's a myth. The cliffs are real enough, but there's no evidence anyone ever jumped off them. The Vikings had to figure out a way to care for these people, just like the rest of us. [ Music ] Brooks: The weeks I spent following Evan, a period that ended with him in this hospital bed, were critical weeks for him. It was also a critical period for San Francisco, when the city began to change its approach to people like Evan, people who are in need of real care and whose presence threatens the health of the city. From The Atlantic, this is No Easy Fix Episode 1, 'The Vanishing Point.' [ Music ] Brooks: Back in the first years of the pandemic, a new type of video started showing up on YouTube and other corners of social media. Brooks: They had titles like 'I Investigated the City of Real Life Zombies' and 'I Investigated the City Where Every Drug Is Legal.' Oliveira: Rampant homelessness, deadly drug addiction, and unpunished shoplifting and car break-ins. Businesses are fleeing, and the city is dying. But how did it get to— Brooks: What they were showing, to audiences of millions and millions of people, were these places in American cities where it felt like the social order had broken down completely. City blocks and encampments crowded with people injecting, overdosing, and dying—all right out in the open. Oliveira: —the center of America's drug epidemic, overrun with a drug known as 'tranq,' a mixture of horse tranquilizer and fentanyl that's turning people there into real-life zombies. Brooks: It wasn't just San Francisco in the spotlight. There was Kensington Avenue in Philadelphia, Skid Row in Downtown L.A., encampments underneath I-5 in Seattle, the storm drains under the Las Vegas Strip. There were, and still are, livestreams of these places broadcasting these images 24/7. [ Music ] Brooks: The videos gave these places a new notoriety. And it was San Francisco—specifically, the Tenderloin neighborhood—that was maybe the most infamous. There was the reality of the thing, and I'll just give one stat here to illustrate this: In this period, nearly twice as many people died of overdose in San Francisco than died of COVID-19. Fentanyl killed far more people than the pandemic. Then there was this contrast that wasn't quite the same as anywhere else: needles and human waste covering the sidewalk, signs of the most self-destructive, destitute humanity, in the same city at the cutting edge of this new technology that can write and speak like a human. Joe Wynne: From the outside, it's, like, this really grotesque cesspool, but once you're in there, it's a bizarrely normal social situation. Joe Wynne has spent a fair amount of time among people dealing with addiction in the Tenderloin, not because he's lived there himself, but because he is Evan's best friend—from before Evan got wrapped up in fentanyl. Brooks: Do you remember the first time you met Evan? Wynne: Yeah, he was a mechanic at this high-end, custom 4x4r shop in North Carolina. Brooks: Before living on the streets in San Francisco, Evan worked as a mechanic in North Carolina. The shop he worked for is a sort of Pimp My Ride for wealthy, crunchy digital nomads looking to live the van life for a while. Joe is not a digital nomad, but he's wealthy enough and at least a little crunchy. So back then, he enlisted Evan and the shop where he worked to outfit his camper van. At the time—this was around 2013—Joe was traveling and living out of his van and, with it in the shop, didn't have a place to live. Wynne: And Evan was like, You can sleep in my basement. And after, like, half a day there, they're like, Oh, you can move into the guest bedroom; it's totally available. You're not a crazy person. Brooks: So Joe and Evan became friends not so long ago because Evan offered Joe a place to stay. And they had a lot in common: They both love cars, they both became fathers when they were quite young, and they're both relentlessly outgoing. Wynne: He's one of the most charming people I've ever met. If you leave him alone in a group of four or five strangers, he will be best friends with everybody inside of 30 minutes. He's absolutely a life-of-the-party kind of guy and not in the big, loud, over-the-top way, in the kind of goes around and has a really great conversation with everyone where they feel like the center of the room. That's really his superpower, is, I feel like, is that type of little conversational loop with people. Brooks: When Joe's van was finished, they went their separate ways. Eventually, Joe went on to start a cannabis company in Northern California; Evan stayed in North Carolina. But they stayed in touch, got to know each other more, and Joe started noticing another side of Evan too. Wynne: There's, like, two sides: There's Evan and Melvin. Melvin is malicious Evan, or, like, the evil side inside of him that completely takes over, but I almost never see it. I see the aftermath of it, but he never lets me see full-blown. Brooks: If there were drugs around, Evan would do as much as he could. To Joe, it felt like he didn't understand how a sacrifice in the present might be beneficial in the future. [ Music ] Despite the lurking threat of Melvin, around 2016, Joe convinced Evan to move out to California to work for him at his cannabis company. They manufactured the oils in THC pens. Evan managed a team; Joe considered him his right-hand man. Joe had a strict 'no hard drugs' policy for his employees, and one day, Evan slipped. Wynne: So I had a drug-test kit on-site, so I told him, I said, Hey, we're going out back, and let's go piss in a cup. And he was like, Oh, oh, oh —you know, he started to freak out. And I tested him, and it was the thickest blue line for positive opiates ever, so I took him back to his room, and we loaded up everything he owned, and I said, I just can't carry you if you're gonna do that. It was excruciating, man; it was bad, and I knew it was gonna go worse. But I just couldn't have it go worse in my living room. I had a lot of people who were counting on us to make good decisions to feed their families. And it was one of the toughest days ever in my business career 'cause he was absolutely my best friend, and I felt like, that day, I felt like it was like signing his death warrant. Brooks: Once he separated from Joe, it didn't take Evan too long to make his way down to San Francisco. When Evan discovered that he could shoplift and sell what he stole and buy fentanyl all in the same place, he never left. That economy, the ease with which he could support his habit, is what kept him there. Joe went on to sell his company for a lot of money. He told me that after the sale, many of his employees got bonuses big enough for a down payment on a house. Evan, meanwhile, stole Tide Pods and slept on the street. Wynne: I would fight anything to change it. If there was any series of tasks I could go through to get my best friend back—even if I didn't get him back, even if he just got his life back—I would go through hell, 'cause like Evan, I love a challenging, knives-and-daggers, bleeding-in-the-streets fight for something that's worth it. And for my best friend who helped me—I'm living my dream life right now: I live in my dream home with the greatest partner I could ever have. My kid goes to a wonderful school and is blossoming. The car that me and Evan always talked about—the insanity car, the insane race car—it's in the garage, right? Brooks: (Laughs.) Wynne: And I've completed all life dreams, and I'm having to literally spend time making up new ones. I would do anything to help him get back his portion of the dream 'cause he helped me get mine. Brooks: Over the years, Joe has tried to give Evan back his portion of that dream. One time, he tracked Evan down in the Tenderloin, rented a penthouse suite for them both, with a Jacuzzi tub. I've seen the pictures of Evan looking like a wet dog in a tub he has single-handedly turned absolutely filthy. Joe tried, simply, to return that favor that Evan offered him when they met: a place to live. Wynne: I was just like, Hey, and I talked to him about it, and I said, Hey, I'm living alone on this land up north. The wife has not moved in. I was like, You could move in and go through horrific withdrawal and be a total piece of shit, and nobody would know except me. You can hang out. I'll put you on salary. You'll make a little money — Brooks: Yeah. Wynne: And he was like, he just literally said it: He's like, Yeah, I'm not done yet. (Laughs.) I'm not finished — Brooks: Not done yet? Wynne: Yeah. I'm not—I don't think I'm done yet. [ Music ] Brooks: Evan is just one of over 4,000 unsheltered people living in San Francisco. 'Unsheltered,' by this count, means living on the street, bus stations, parks, tents, and abandoned buildings. There are around 4,000 more in temporary shelters. Nationally, those numbers are even more grim. In 2024, the number of people experiencing homelessness on a single night was 771,480, the highest number ever recorded in the United States. To be very clear, 'I'm not done yet' is by no means a representative attitude of that whole. Unsheltered life is grueling—sometimes violent, and often deadly. Evan's willingness to leave that behind, or not, doesn't change that fact. There are many reasons why so many people in America are homeless, first among them being a lack of homes. It's no coincidence that things are so rough in one of the most expensive cities in America, while in places like West Virginia, which has its own opioid crisis and much cheaper housing, unsheltered homelessness is much more rare. [ Applause ] Brooks: This year, San Francisco elected a new mayor, Daniel Lurie, an ultra-wealthy moderate in a city famous for its progressive politics. Daniel Lurie: Today marks the beginning of a new era of accountability and change at city hall, one that, above all else, serves you, the people of San Francisco. Brooks: The new mayor has his work cut out for him. San Francisco has become emblematic of what sometimes gets called a 'doom loop,' something that has happened in a lot of cities since the pandemic. In this loop, the office buildings empty out because of the pandemic and remote work. The stores and restaurants that served office workers are forced to shutter. Crime soars. Tax revenues fall. Public transportation is forced to cut back, so even fewer people come downtown. And on and on and on. Lurie is not a tough-on-crime mayor. He's not gutting the city's addiction and homelessness services. But the way he spoke about these problems, which was the first topic in his inauguration speech, was different. Lurie: I entered this mayor's race not as a politician, but as a dad who couldn't explain to my kids what they were seeing on our streets. Brooks: Lurie talks about what he could see—what the problem looks like, the effect of this constant onslaught of imagery on individual well-being. Lurie: Widespread drug dealing, public drug use, and constantly seeing people in crisis has robbed us of our sense of decency and security. Now, safety isn't just a statistic; it's a feeling you hold when you're walking down the street. That insecurity is— Brooks: One reason he might be using these terms is that, by the numbers, the unsheltered, visible homeless population in San Francisco is nearly the same as it was 10 years ago. What has changed is everyone else. It's hard to get exact numbers, but downtown San Francisco has lost about two-thirds of its daytime population—that's hundreds of thousands of commuters and office workers gone, which leaves just Evan and people like him. This, in short, might be called a visibility problem. People feel scared and maybe a little ashamed having to see so many people experiencing homelessness every day,which is an odd problem because for many people living on the street, a family member, or a loved one, is looking for them. [ Music ] Brooks: Visible to a city that sees too much of them. invisible to families who would love nothing more than to see them. That's after the break. [ Break ] Brooks: In late February, about six weeks before Evan would find himself in the hospital, I met Liz Breuilly. Liz is in her 40s and lives in the mountains outside of San Francisco. She lives a sort of double life. Her day job is in the medical field, and in her spare time, she does something else. Liz Breuilly: I'm not a private investigator. Nobody's paying me and nobody's licensing me to do the work that I do. Brooks: How would you describe what you do? Breuilly: (Laughs.) I feel like I started doing one thing, right, in the beginning, several years ago, and I feel like it's evolved into many different things. Brooks: Mm-hmm. Breuilly: Primarily, I would say that I locate missing persons that are either mentally ill, drug-addicted, and/or experiencing homelessness. Brooks: Liz finds missing people. She does this for free. I've asked her probably 25 times why she does this, and even to her, it's not clear. [ Music ] What is clear is that there's plenty of finding to do. There are around 1,400 people on the San Francisco Police Department's missing-persons list. And given that 'missing' just means that someone somewhere is looking for you—and has filed a police report—that number could be much higher. [ Music ] Brooks: Liz and others who spend time in the Tenderloin and encampments think that many of these people are here—which is strange, considering all of these disappeared people are far more visible than those of us spending our days in cars and offices, our nights in houses and apartments and bedrooms, while they're out on the street, exposed. In these first couple months of the new mayoral administration, the city has been experimenting with new solutions to this problem of unsheltered homelessness and open drug use. There have been mass arrests of dealers and users, pushing the jail population to levels that haven't been seen in years. One corner of the Tenderloin was turned into a triage center, which has since shut down, where people could go for coffee, to be connected with city services, and be offered a free bus ticket out of town, courtesy of the city. But there's no city program that does what Liz does. She's a sort of one-woman case study of a different approach, a radical approach, to this problem: reconnect lost people with their families and see if things change. Breuilly: Most of the time, when families get to me, they think their loved one is deceased. And so they're almost just looking for validation that that's the case, and it's usually not. I have located, I don't know, well over 200 people, maybe 2—I don't even know. It's been well over 200. Brooks: Evan was once one of Liz's lost people. Brooks: Do you remember who reached out to you about him the first time? Breuilly: Mm-hmm, yeah, his sister did. His sister did. He had been missing for several years, and she basically was, you know, said, This is my brother, and I heard what you do, and I'm wondering if you would help me. And I said, Sure. Brooks: There's no big secret to how Liz works. She asks families about their missing person, about their history of addiction and mental illness. She checks arrest records. She's in frequent contact with the city morgue. But mostly, she just adds pictures, like Evan's picture, to a folder in her phone, memorizes faces as best she can, and starts looking. And then, one day, there Evan was. Breuilly: So I roll down the window, and I scream, 'Evan! Evan!' (Laughs.) And he stopped, and he looked at me, and he ... (Laughs.) He basically was like, I don't know you. And I'm shouting at him from my car, and I said, No, you don't know me. I just need to talk to you for a second. And that's what started a, I don't know, four-year friendship, right, with him. Brooks: Did Evan call his sister when you— Breuilly: No. Brooks: —caught up with him? No? Breuilly: No, he did not. He just couldn't do it. Brooks: A lot of people who Liz finds don't call their families. Many of them do call but don't leave the street or go home. One person I met through Liz put it this way: 'I don't want to be missing, and I don't want to be found either.' So this limbo—not missing, not found—is where many of Liz's people stay for years. Breuilly: Every time they hear about someone overdosing or every time someone posts a video of a sheet over somebody, I'm getting a phone call from five parents asking me if I know who it is and if that's their kid. Brooks: Liz and I are driving around downtown San Francisco. A lot of open drug use and encampments that were concentrated in the Tenderloin are now more diffuse. In the Mission District, the alley behind the Everlane is packed with people smoking, injecting, laid out. Once in a while, a cleanup crew drives through, clears everyone out, hoses the alley down, and then everyone comes back. Breuilly: People were never spread out like this. I mean, there would be, in certain areas, I mean, at nighttime, there'd be 250, 300 people. And at nighttime, it still gets like that when the cops run around, but because the cops are really doing a lot of work with patrolling and doing all this stuff, it breaks them up. Brooks: Today, Liz has been looking for one guy in particular. A few weeks ago, he had asked her to find his mom, and Liz learned pretty quickly that his mom had passed away. Breuilly: So—but I also know that if I don't tell him, no one else will. Brooks: Yeah, 'cause nobody even knows, right? Breuilly: Yeah, and the only way to reach him is to do what we're doing today, which is going back out on the street to find him. Brooks: Late in the afternoon, she sees the guy she's looking for. Breuilly: I think that's him. I think that's the guy. Brooks: The man is wearing a red flannel and a corduroy jacket, with a set of neon ski goggles around his neck. He's half-standing out of his wheelchair, leaning over a row of trash cans, digging through the garbage and throwing things aside. Here's what will happen next: Liz will tell him the news—that his mother has passed away. He will cry and thank Liz for telling him. They'll smoke cigarettes together, even though Liz doesn't smoke cigarettes, for 10 minutes and then 20 minutes as he tries to adjust to this new reality. But before any of this can happen, there's a problem: The street we've pulled over in is narrow and behind us, suddenly, is a white Jaguar SUV with no one in the driver's seat. A self-driving car is stuck behind us, with traffic backing up behind it, preventing this volunteer bearer of the worst possible news from doing her job. Breuilly: Well, it's definitely a feeling of helplessness, right? This kid is very, very sick. Yes, am I glad I was able to give him the information and hopefully set him free a little bit from this persistent state of looking? But in the same respect, it's like I'm leaving somebody a little bit worse than in the situation they were in. And so it's deflating because, even me, who is really—I know the resources in the city. But right now, there's nowhere to take no space in shelters. He doesn't have a phone. I can't bring him home to my house. What am I gonna do? [ Music ] Brooks: It's not just San Francisco trying to ram a metaphorical self-driving car through a metaphorical alley of grief. Cities around the country are desperate to move on. Portland, Oregon, elected a new mayor who pledged to end unsheltered homelessness, after the state re-criminalized drug possession, after decriminalizing in 2021. Philadelphia, Pennsylvania, elected a tough-on-crime mayor, and hired more police. Fremont, California, criminalized not just homeless encampments but 'aiding' and 'abetting' homeless encampments in any way. Everyone, from city leadership to regular people like Liz, seem desperate to move on and willing to try new things. Liz, in part, does this work because no one else will. Brooks: It's night now, and Liz is still out looking for a few missing people. And, tucked up behind the passenger-side visor in her car, Liz has a bundle of printed-out emails from Evan's family and a picture of his kid, a middle schooler now, playing the clarinet. At night, the plaza at 16th and Mission turns into a packed open-air market of stolen goods. The sellers, mostly are addicts, are hawking used clothes, kids' toys, tamales, phone chargers, a tricycle, and remarkably, tonight, an enormous slab of bacon. The shoppers are mostly low-income San Franciscans chasing a good deal. Behind them are the dealers, many of them young H onduran men in masks. Hundreds of people are walking around this dark patch of concrete. Cash moves in one direction: from the buyers to the sellers to the dealers. Standing on one corner, leaning against a street sign, is Evan. Evan: Every time, every time—like, the last, what, like, five times, it seems like—I've been like, I really need to see Liz today. I need to see Liz. Today, I literally kept thinking today— (Dog barks.) Evan: —I was like, I need to find her. I need to find her. Breuilly: Here I am. Brooks: This is the first time I met Evan, weeks before our conversation in the hospital. Evan is looking shaggy, but in relatively good health. And he swears that when he needs Liz, he can manifest her. Breuilly: How are you, though? Why did you manifest me? Evan: Because I'm, I have to figure something out. Breuilly: Okay, what've you got going? Brooks: Evan tells Liz that he hasn't been able to keep much food down for weeks. And his legs are infected and extremely swollen. Leg infections are common for fentanyl users like Evan due to contaminants in the supply and side effects from injection. It's why you see so many people in wheelchairs. Breuilly: How is it? Ooh, it … (Gasps.) Evan: Yeah— Breuilly: Evan! Evan: I know, that's what I'm saying. So I need, I need some, I need, I'm—I, with my leg and my stomach, I was like, I'm over this. Breuilly: Oh, wow. Evan: I'm so over it. I'm so over it. And I'm, like, I'm just ready— Breuilly: Pitiful. Evan: —for something to change, something— Breuilly: Yay! Evan: (Laughs.) Brooks: Liz, as Evan is speaking, is beaming. This was a full 180 from the 'I'm not done yet' Evan told Joe when he tried to get him off the street a few years ago. This was the first time in the years Evan and Liz have known each other that Evan has said he wanted to get off the street and get off fentanyl. Evan: Yeah, I'm falling apart, and I'm, in a way, I'm kind of glad. (Laughs.) 'Cause I'm—it's kind of making me turn to stop. Brooks: Yeah. [ Music ] Brooks: It might not sound like much, but when someone like Evan, who has been addicted to opioids for many, many years, says, 'I'm ready,' this is the moment that San Francisco's, and many cities', strategy to address this problem is built on. So here we were: Evan is ready to get off the street; the city of San Francisco is eager to help. Evan's readiness is supposed to trigger action—a chance to put a dent in this visible suffering that haunts the mayor and so many other San Franciscans. Plus, Evan's got Liz, who has a car and a phone. How hard could it be? That's next week. No Easy Fix is produced and reported by me, Ethan Brooks. Editing by Jocelyn Frank and Hanna Rosin. Engineering by Rob Smierciak. Fact-checking by Sam Fentress. Claudine Ebeid is the executive producer of Atlantic audio. Andrea Valdez is our managing editor.
