Years into an overdose crisis that’s left thousands dead and months before the county implements a state law expected to put more pressure on the treatment system, the county still has just 78 detox beds at its disposal for San Diegans with Medi-Cal insurance.
For years, often-desperate homeless and low-income San Diegans have virtually been unable to access withdrawal management beds on demand, meaning some never access a supportive place to safely stop using and continue using. This can mean people grappling with addiction and asking for help risk death rather than begin the often-excruciating process to get sober on their own. The situation only got more tragic as fentanyl became more pervasive, leading to more than 3,100 overdose deaths in the county since 2019.
The stakes are likely to get even higher in five months.
The county is set to implement a conservatorship expansion law in January that will make people with severe substance use disorder eligible for involuntary holds, a change that’s expected to put more strain on both local hospitals and a treatment system unable to meet existing demand for voluntary care.
The county and other stakeholders are scrambling to prepare as Gov. Gavin Newsom urges them to implement SB 43 sooner. They are making plans to educate police and others about the state law, assessing the existing treatment system, assembling teams to help connect surviving overdose patients who end up in hospital emergency rooms with care and advocating for regulatory changes to allow patients to be treated outside chaotic ERs.
But the county is still struggling with a big conundrum: Where will people grappling with severe addictions go after they are picked up on involuntary holds, particularly if they desperately need a place to detox?
While the county’s behavioral health director says detox programs aren’t the only answer to that question, community leaders and advocates believe they are a crucial resource.
County Behavioral Health Services Director Luke Bergmann says officials are “taking as aggressive an approach as (they) can” to add more detox beds along with other treatment options.
The county has tentatively awarded a contract to Escondido-based Interfaith Community Services to open an additional 21 county-contracted detox beds in hopes that they’ll open by January. The county is also waiting for four contracted detox beds for young adults to open at an Episcopal Community Services property in Hillcrest. Nonprofits Father Joe’s Villages and Genesis Recovery also want to separately open Medi-Cal-serving detox programs with 45 beds in downtown San Diego and 24 beds in Dulzura early next year though they’ll need to clear multiple hurdles to deliver them. Neither has been assured they’ll receive county contracts.
Meanwhile, the county plans to in early 2026 open a 72-to-96-bed treatment center that includes detox services at a long-shuttered treatment facility in National City.
If these efforts are successful, it’d be a massive expansion. For now, the county only has 78 detox beds contracted to serve Medi-Cal patients.
If all goes as hoped, the region will more than double its roster of detox beds for Medi-Cal patients countywide come early next year – and there would be about 50 detox beds in the city of San Diego. The city now just has two detox beds under contract with the county to serve Medi-Cal patients in the city of San Diego, home to nearly half of the county’s fentanyl deaths in the past five years per the Medical Examiner’s Office.
For now, a shortage of detox beds and programs that can treat detox patients experiencing medical issues plus complicated intake processes have made quickly obtaining a bed comparable to winning the lottery. This means that some people never get one, put off recovery and risk death.
The current reality is so dire that Laura Chez of We See You San Diego, which organizes weekly dinners for homeless residents in Pacific Beach, said her organization decided to take matters into its own hands with the help of donors after failed attempts to get participants into county-contracted beds.
Chez said her organization has so far this year paid thousands of dollars each for 16 people to go to private facilities that don’t serve Medi-Cal patients to detox from fentanyl.
“I don’t have time to be mad at the broken system,” Chez said.
The current reality is also heartbreaking for providers long determined to add more detox beds for Medi-Cal patients.
McAlister Institute, the region’s largest substance use treatment provider, has spent years searching for a suitable site to put beds, deciding against more than 50 properties in the process. It’s struggled even with $12 million in pledged local government support.
“People are dying on the streets while we are doing everything we can, and it still doesn’t feel like enough,” Marisa Varond of McAlister said last year.
Property restrictions, bureaucratic red tape and a competitive real estate market have stifled other providers too.
One of them, Interfaith Community Services, recently was the winning bidder in a county request for proposals process and plans to add 21 beds by early next year.
Like Varond, Interfaith CEO Greg Anglea said his organization regularly must tell people desperate to start their recovery journey it doesn’t have an opening for them – and that’s prior to the state conservatorship expansion.
“There aren’t beds for people to get into right now,” Anglea said. “Our work to expand access to treatment is not predicated on SB 43. It’s predicated on the daily lack of beds that we see and the people we have to turn away from treatment today and the need to be able to bring somebody into treatment when they’re ready and willing.”
Josh Bohannan of Father Joe’s Villages and Julie Hayden, who leads both Genesis Recovery and homeless-serving East County Transitional Living Center, say they are determined to add beds for similar reasons. Hayden estimated its campus in El Cajon now must turn away nearly a third of people who try to enter its programs because they’re dealing with active addiction or mental health issues. She believes detox beds could dramatically reduce this outcome.
Both Father Joe’s Villages and Genesis Recovery are now trying to raise money to open detox programs.
Bergmann of the county says his team is hustling too.
While he acknowledges the community focus on detox beds, Bergmann said he sees another level of care – crisis stabilization units located throughout the county – as the more likely initial landing places for people picked up on holds when SB 43 takes effect.
Bergmann and other county officials have been lobbying the state to allow crisis units that now solely treat mental-health patients for up to 24 hours to also receive reimbursement to serve patients with substance use disorders.
If state regulations are amended, Bergmann believes diverting patients to crisis units can help many avoid bustling hospital ERs and get directed to other services that fit their needs.
“A lot of what we would do at the (crisis unit) would be navigating people to ongoing care,” Bergmann said.
He also noted that few existing detox programs provide medical oversight, meaning that hospital ERs – and in some cases, crisis units – will be better equipped to serve people with other conditions that disqualify them from most county-backed detox programs.
Hospitals haven’t been eager to take on more patients with substance use disorders and advocates have feared what might happen if these patients come into an ER only to be discharged once they sober up and are no longer considered eligible for a hold.
Nathan Smiddy, a project manager for the Harm Reduction Coalition of San Diego who is in recovery and has helped countless people struggling with addiction, said he worries about more patients being held in the hospital for up to 72 hours under SB 43 and then being released to the street without a safe place to continue their recovery. Those who are addicted to opioids could leave the hospital with a reduced tolerance that makes them more vulnerable.
“It puts them at an increased risk of overdose and death,” Smiddy said.
He believes that SB 43 will lead to civil liberties violations and is concerned it will simply do more harm, especially without a dramatic increase in recovery resources like detox beds.
San Diego Mayor Todd Gloria, one of the foremost champions of SB 43, has for years urged the county to add more detox beds.
He argues they are better equipped to serve people who need to sober up and safer than jails where some might otherwise land.
Gloria said he’s also heard frustration from outreach workers and police for years about the existing shortage of detox beds.
“I personally think that’s where we can get the most bang for our buck in the short term,” said Gloria, who acknowledged the county needs to add other services as well.
Indeed, traditional detox beds aren’t equipped to serve all patients with severe addiction issues – or to serve those put on longer-term holds that require locked facilities.
Though it’s unclear what the demand might be under SB 43, the county doesn’t have locked treatment programs for people whose primary diagnosis is a substance use disorder or contracts with chemical dependency hospitals for people with substance use disorders with Medi-Cal insurance. Some providers are convinced these services are needed for substance use patients who need medical support – or are deemed gravely disabled.
The county has been in talks with the local Hospital Association and the state on how to address these gaps.
For now, Bergmann said, the county is counting on local hospitals to care for higher-need patients.
Still, Bergmann said the county must rally to increase options and capacity to serve patients struggling with addiction, including those who aren’t now seeking care.
When he discusses this, Bergmann often cites a federal Substance Abuse and Mental Health Services Administration survey that found 94 percent of adults and teens with substance use disorder didn’t get treatment in 2021.
“The need is profound, and we need to build a service system that builds more towards need than simply toward demand,” Bergmann said.
More useless Virtue Signaling as in the Camping Ban, Involuntary Holds, on and on. This way they can say to gullible voters, “We took Decisive Action!!” They took action all right, knowing there was no place for the homeless to go and no beds for the addicts. The voters have been conned again. How very Trumpish of you.
Is this a specific on general shortage? How many detox beds are in the county for non-Medicare patients?
And the “94% didn’t receive treatment” statement was not about access for the unhoused, as implied here. The nation survey, which surveyed the general population (not specific to the unhoused) also stated: “Yet 96.8% of individuals with an illicit drug or alcohol use disorder that didn’t receive treatment at a speciality facility said they didn’t feel they needed treatment.”
If there is a shortage of detox beds, then stop importing drug addicts to San Diego and instead spend the money to stop the flow of drugs into this country. Build it and they will come, resulting in more waste of taxpayer money and a very decline in the quality of life in San Diego and California as a whole. The Democrats are destroying the USA!
I’m curious if there’s any estimate to how many detox beds there should be available? Theres clearly a huge shortage, but I’m wondering what the goal should be.