"We can't just take the approach that we've been taking and kind of assume that everyone wants the services that we offer," said Dr. Gary Tsai, director of the Substance Abuse Prevention and Control division at the L.A. County Department of Public Health. "That's just not the reality."

His department is trying to nudge addiction treatment facilities to change their approach, by offering financial incentives for those that meet R95 requirements. Among them: changing their rules to not automatically eject people who have a "lapse" of drug use.

Fernandez, whose organization is participating in R95, said abstinence is still its aspirational goal — and "we still have the ability to use our own clinical judgment on a case-by-case basis," such as if people endanger other participants. But "we shouldn't have blanket policies."

To get R95 funding, they also cannot require people to be totally abstinent before being admitted. And under R95, treatment programs are also being encouraged to partner with syringe programs rooted in "harm reduction" — a philosophy focused on minimizing the harmful effects of drug use — to address the needs of people who may not want to enter or remain in treatment.

Some treatment providers "view us as the enemy instead of as allies," said Soma Snakeoil, executive director of the Sidewalk Project, which provides Narcan spray to reverse overdoses and other services on L.A.'s Skid Row.

With R95, she said, "the biggest change is that harm reduction organizations and treatment providers are talking to each other in a way that was not happening before."

The county is also prodding addiction treatment facilities to reexamine whether the way they operate could be turning people away, and look more closely at the "customer experience." Tsai compared the situation to a restaurant drawing few customers: "How do we get more people in the door?"

Too often, "the drug dealers do a much better job of delivering their product to our patients than we do," said Dr. Randolph Holmes, chair of government affairs for the California Society of Addiction Medicine.

When Johnny Guerrero decided to get off Skid Row and go into residential treatment in Los Angeles, he was initially turned away because he had arrived "late — maybe 10 minutes late," the 35-year-old said.

He was only able to get in, he said, because the harm reduction worker who had taken him to the facility let him stay the night at her home, then brought him back the next morning. Even then, "there was so much paperwork. I was so dopesick. There was just hurdle after hurdle after hurdle."

...continued

©2024 Los Angeles Times. Visit at latimes.com. Distributed by Tribune Content Agency, LLC.