An examination of class-based substance and addiction disparities in Northern California

“Psychedelics open you up to the possibility that everything you know is wrong.” A quote from 1990s author and philosopher Terence McKenna that seems more relevant today than ever before.

Psychedelics are currently experiencing a mainstream renaissance. Microdosing, in which the administration of minuscule doses of hallucinogenic drugs gear the brain towards a subconscious trip, has become not only an accepted, but an embraced practice in Silicon Valley tech culture. Many tech executives are now using substances such as LSD to boost creativity and cognitive function — the Bill Gates’ of the future are taking cues from the Steve Jobs’ of the past.

While microdosing and the psychedelic resurgence has been an aspect of ‘brain hacking’ within tech culture for a few years now, Northern California is just now beginning progressive efforts to combat their decades-long local opioid crisis.

How has this substance-based disparity existed for such a long time? In an area which, in the words of the San Francisco Chronicle, “is one big unsafe injection site,” how has the opioid crisis been neglected while psychedelics have been embraced? There lies an ubiquity of dirty needles across the alleys and parks of the Tenderloin while tech executives in the buildings above microdose. In an area as metropolitan and condensed as San Francisco, both sides of this ‘drug coin’ coexist, but in a perpetual state of imbalance in treatment and attention.


Photo by Aaron Diggdon

Just as the Woodstock-ian hippies of the 1960s were (mostly) allowed to trip freely while minorities were targeted by President Nixon’s War on Drugs, those who microdose in tech have been empowered while solutions to addiction issues have been mostly disregarded. In a city of innovation, this discrepancy seems ignorant, and quite frankly, un-innovative.

Mark O’Leary is a sergeant for the Tenderloin Police Department. He deals with issues regarding opioid abuse on a regular basis, and he sees an overarching trend of indifference in regards to the public health response. “People get brought in on 5150s (a police-mandated 72 hour psychological hold) and they’re in one door and out the other, sometimes within a couple hours,” O’Leary says. “The treatment just isn’t working.”
More than anything, O’Leary’s tone illustrates the institutional dejection inherent in the system. He speaks with a tinge of resigned apathy, his diction a somewhat disheartening vocal equivalent of a shrug and a sigh. It’s hard to blame him. The tireless labor of officers such as O’Leary remains fruitless in regards to addiction, their efforts rendered moot by a mental health system lacking both the monetary resources and empathetic capacity to treat such a uniquely Sisyphus-ian issue.

With every repeat offender, the outlook of the public health system seems to grow increasingly bleak. Clearly established patterns of exploitation and ignorance leave both medical professionals and opioid addicts at a crossroads.

One solution could be safe injection sites. These sites have existed in some European cities for decades. However, they tend to exist in places with progressive drug policies. Major pioneers in the field include the Netherlands and Portugal, countries which decriminalize all forms of drug possession. While motions such as California Prop 47 have accomplished similar feats in America, our national sentiment toward addiction as a whole continues to stray more towards criminality than disease. This inconsistency has inherently stalled, if not entirely prevented, effective mindsets and initiatives towards the opioid crisis on both a small and large scale. More than anything, this serves as a representation of a demographic divide on an institutional level. Experimental studies involving the use of illicit psychedelics — ecstasy for post-traumatic stress disorder, psilocybin (commonly known as ‘shrooms’) for end-of-life anxiety, and ketamine for depression, to name a few — are being approved at an increasing rate.

These studies exist in realms of social stratification and class divide as much as they do in a realm of psychedelia. The demographic distribution of testing, or lack thereof, is a reflection of categorical segregation as much as it is innovative experimentation — the issues that psychedelics can purportedly solve, such as PTSD and depression, are as pervasive in at-risk communities as they are in the upper echelons of society. If the mental health issues are consistent between class lines, then shouldn’t priority fall on those who have depleted access to assistance and treatment as much, if not more, than those who can finance their own rehabilitation?

Amsterdam is the hub of safe injection sites within the Netherlands. It is not just the existence of the sites themselves, but rather their geographic placement, that speaks to the strategy behind the Netherlands battle against opioid addiction. Injection sites occupy areas with the highest wealth disparities, thereby offering access to all who need it regardless of their place on the socioeconomic spectrum. Their treatment is determined by need rather than wealth. (Click link for relating infographic.)

In turn, the Netherlands has found a great deal of success in regards to control and treatment of opioid addiction. According to the 2018 Netherlands country drug report, there is a rate of 1.3 per 1,000 citizens for high-risk opioid use, a rate that ranks among the best in the world, especially in countries with highly urbanized populations. The distribution of approximately 237,400 clean syringes in the past year and the constant increase of safe injection programs over the past decade has led to plummeting HIV and addiction rates.


Photo by Aaron Diggdon

This is precisely why some, such as Sergeant O’Leary, are skeptical of safe injection sites. While the ultimate goal is harm reduction, there is also the risk of the sites causing harm in different ways than dirty needles and overdoses do.

“If you have large numbers of people addicted to drugs going to a place to shoot their drugs, that’s not necessarily a bad thing,” O’Leary remarks. “But when you take that same number of people that aren’t meaningfully employed and they all migrate to the same place, it’s going to be easy to look around the area and see a lot more crime. It won’t solve the problem, it’ll just centralize it.”

Ryan Bunag works at Shiekh Shoes on Market Street, about a block down the street from the San Francisco AIDS Foundation, the proposed location of the first safe injection site. He believes that harm reduction isn’t worth the encouragement of use.

“I don’t like the idea of a safe injection site at all. I think it supports a negative habit.”

A few blocks away, Ezekiel Addison fiddles with a Xanax pill at Larkin Street Youth Services in the notoriously run-down Tenderloin neighborhood. The clinic, which serves as a daytime safe haven for at-risk teens from the ages of 12-24, seems to serve as a representation of the surrounding neighborhood due to the predominantly unique coherency of the youth that inhabit it. Their issues of addiction and poverty remain the same, however, the mental decay seen in the surrounding adults has not yet took its hold.

There is a palpable sense of suppressed dread among these teens — intelligent enough to recognize their role in a vicious cycle, they find themselves in a state of stagnancy due to a seemingly preeminent feeling of survivor’s remorse. The kids hold each other together, for better or for worse. Regardless of how much they want to get ‘out of the hood’, the issues of addiction, poverty and unemployment that affect their surrounding elders are already taking hold. I witness one teen selling a pound of marijuana to another just outside the door of Larkin. Another hands out pills, presumably Xanax, out of a toothpaste bottle.

Whether or not each individual at Larkin has a specific opioid addiction of their own, it has affected all of their lives, whether it be through themselves, friends or family members.

Addison remains on an intermittent phone call throughout our conversation. The language is mostly indeterminable, a mixture of muttering and local colloquialisms that seem to be placed in the context of some sort of drug deal. “I don’t agree with that shooting up stuff,” he remarks, washing down his Xanax with a gulp of Sprite. “I don’t agree with opioids, heroin, any of that shit.”

It is telling that Addison voices his disagreement with opioids as he ingests a benzodiazepine in the main lobby of a center for at-risk youth. Addison disagrees with opioids, yet finds no problem with himself popping Xanax. Similarly, there is a negative connotation surrounding opioid use which hinders support for effective treatment programs (such as safe injection sites), even as society welcomes and accepts microdosing.

But when asked about the possible implementation of a safe injection site, Addison sees the value through the lens of his own personal experiences. “San Francisco kind of already has that within the community. I’ve passed out a few clean needles myself. A site could definitely help.”

Let’s recap — Addison is an active user of Xanax, yet he looks down upon opioid use. But he still gives out clean needles and supports a potential safe injection site. It doesn’t seem to add up, does it? In a vacuum, this inconsistency is representative of the larger issue surrounding opioid addiction and treatment. There is no consistency.

Regardless of the karmic efforts of Addison and others like him within the community, it’s clear that a few occasional clean needles passed out among the homeless is an incredibly temporary solution to an increasingly permanent problem. Those within the community recognize issues of addiction more than those on the outside looking in.

“Yung Sammy, better known as Mario,” smokes a Newport cigarette as Addison introduces us. In his 19 years, he has firsthand experience with San Francisco’s drug disparity. “The rich people, they’re taking it, but nothing can happen to them. Even if it does, they get an ambulance immediately. If something happens to one of these people out here, the ambulance just isn’t coming in time.”

Sammy’s remarks reflect exactly why many believe that a safe injection site is a necessary measure. As public health efforts have proven their ineffectiveness time and time again, Sammy and his peers in the neighborhood continue to see opioids wreak havoc on their friends and family.

“My family members shoot up. My auntie. We need a couple of those sites to help people out. These motherfuckers need help — all it is is a cry for help. A greater demon they’re fighting, why they choose to go to the drug. But most people just treat them like bums, and that’s why they stay on the street.”

He raises an important point. Opioid addiction does not materialize out of thin air. In most cases, addiction is intrinsically reflective of a greater sense of mental instability. Just as Xanax can act as a universal remote based in reality, allowing its users to ‘fast-forward’ through days with ease, opioids are used as a sort of mental ibuprofen. Father in jail? Take an oxycontin. Broke and hungry? Street heroin is cheap. The cycle continues.

But imagine if the gargantuan socioeconomic gap between microdosers and opioid abusers somehow dissolved. Would it be all that different? Just as opioid use tends to be used as an antidote for internal strife, microdosing is a mental remedy for creativity, focus and motivation. As one investment banker put it in a 2016 VICE article: “When I’m microdosing, I’m 100% Wolf of Wall Street.”

Quantitatively compared, microdosing is to cognitive function as opioids are to mental health. At their root, both groups of users are seeking the same thing. But microdosing is a solution, and it is a solution that can realistically work. The suppression and self-medication of mental health issues with opioid use is a problem.

This is where the disparity lies.

In our news cycle, we celebrate solutions. It’s easy to celebrate a positive trend. But we lament problems. And it’s easy to complain about a negative issue.

The inherent sense of helplessness in San Francisco’s opioid issue has stalled positive reform more than anything else. Defeat is not reached as an outcome, it is assumed. This assumption seemingly explains the constant ingestion and exchange of substances in a place like Larkin, somewhere that should probably be looking to solve issues rather than propagate them with a ‘don’t ask, don’t tell’ substance policy. In and of itself, this continuum serves as the basis of harm reduction strategies within a landscape that has all but admitted defeat. At this point, many believe that the best strategy is to reduce the damage done by an issue that seems too large to handle. Only time will tell the effectiveness of this collective mindset.

However, the disparity can still be solved. Addiction is a disease. Perception is simply a mindset. Whether it be through the spread of awareness or the recognition of subconscious class-based biases, there’s no excuse for the innovative mindset inherent in microdosing not to be applied to opioid addiction. It’s just a matter of recognition.

As the Larkin crowd disperses, Ezekiel calls me over one last time. He has a few more things to say, and his last remark is telling in its simplicity, especially in terms of the urban drug disparity that has marginalized his community.

“Everybody should be treated equal. It’s just equality at the end of the day.”

If only it was so simple.