Loading summary
Transcript141 lines
- [00:01]
Home Depot Announcer
Right now at the Home Depot, you'll find storage solutions made to fit your needs. Grab an HDX Tuff tote to protect your tools or keep your sports equipment.
- [00:11]
Hanna Rosen
Contained with reinforced snap fit lids.
- [00:15]
Home Depot Announcer
Or stack up and make better use of your space with bins and totes built to last.
- [00:21]
Evan Brooks
Whatever your story, we've got the gear.
- [00:23]
Home Depot Announcer
To keep it organized and protected at the Home Depot.
- [00:27]
Evan Brooks
How doers get more done.
- [00:31]
Susan Eggman
This episode is brought to you by JCPenney. Yes, JCPenney. And if you've been there recently, you know it's the place to go. For jaw dropping looks at brag worthy prices. They've got something special for every style and budget. Not to mention rewards and deals that make finding those hidden gems even sweeter. If you already shop JCPenney, you're already in on the secret. But if not, it's time to ask. Wait, am I sleeping on JCPenney? Shop jcpenney.com yes, JCPenney.
- [01:03]
Hanna Rosen
This is radio Atlantic. I'm Hanna Rosen. 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. We as a city just got to this point where we were like, if somebody wants to keep harming themselves and.
- [01:24]
Evan Brooks
Really killing themselves, that's their right.
- [01:27]
Hanna Rosen
And we followed Evan, who's trying to get off the streets through a critical 48 hour period.
- [01:33]
Home Depot Announcer
I don't know where to go.
- [01:35]
Evan Brooks
And it's raining.
- [01:37]
Home Depot Announcer
I'm cold, I'm hungry, and I'm over it. I'm so over it.
- [01:47]
Hanna Rosen
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.
- [02:05]
Susan Eggman
Hello. Hey, how you doing?
- [02:08]
Hanna Rosen
Doing all right. You know, 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.
- [02:22]
Susan Eggman
I was actually really worried about him and.
- [02:24]
Hanna Rosen
And then he disappeared.
- [02:25]
Susan Eggman
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 going to get better on its own.
- [02:37]
Hanna Rosen
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.
- [02:47]
Susan Eggman
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.
- [02:57]
Hanna Rosen
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.
- [03:09]
Evan Brooks
I was gonna have him get a tattoo with my phone number on it.
- [03:13]
Hanna Rosen
That's a great idea.
- [03:14]
Evan Brooks
Yeah. Yeah. But he disappeared on me.
- [03:20]
Hanna Rosen
This time is different. When Liz called the hospitals, none of them had any record 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? Are you worried?
- [03:45]
Evan Brooks
I mean, it's. I expect Evan to die out there 100%. 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.
- [04:24]
Hanna Rosen
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 from the Atlantic. This is no easy fix. Episode 3 A Golden Opportunity.
- [05:51]
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.
- [06:02]
Hanna Rosen
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.
- [06:25]
Sam 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 going to nod and smile at bullshit when what we really need to be doing is rethinking how this is done.
- [06:38]
Hanna Rosen
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, are 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 who calling for a different approach.
- [07:19]
Sam 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 want to hear that, but in my opinion, that's been a revelation.
- [07:41]
Hanna Rosen
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% 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.
- [08:18]
Sam 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, that's. I mean, I can't tell you how nonsensical that idea is.
- [08:37]
Hanna Rosen
I mean, 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.
- [08:43]
Sam Quinones
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.
- [09:12]
Hanna Rosen
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.
- [09:22]
Sam 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.
- [09:35]
Hanna Rosen
Sam isn't the only one calling for an expansion of involuntary treatment for President.
- [09:41]
Evan Brooks
Trump signing an executive order to end.
- [09:42]
Sam Quinones
Homelessness that has taken over public streets. So let's take a look at how he.
- [09:47]
Hanna Rosen
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, it also supports involuntary treatment, which is crucial if you're going to get people off the.
- [10:10]
Evan Brooks
Streets who don't want to get off the streets, want to quit drugs.
- [10:15]
Hanna Rosen
Involuntary treatment, or as the order puts it, quote, shifting homeless individuals into long term institutional settings. 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.
- [10:52]
Susan Eggman
When we closed the state hospitals, we didn't quite realize, like, oh, but they are serving a purpose. Like these people are being safely housed here. They have food, they have care, they have shelter, all these things.
- [11:03]
Hanna Rosen
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.
- [11:16]
Susan Eggman
We swing as a, as a society, right? We were locking everybody up, throwing away the key, you know, for their safety, for our safety. Now we've realized it's 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?
- [11:36]
Hanna Rosen
Oh, really?
- [11:37]
Susan Eggman
The Judicial Committee would just like, get out of your Eggman, Right? I mean, I'm a huge ACLU lover, right? But they hate me when they see me coming with this stuff.
- [11:46]
Hanna Rosen
The reason the ACLU was 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 and even lobotomize patients the ACLU calls conservatorship. That's 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 SB 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. Can you just introduce yourself? I am April Sloan. I am the assistant deputy chief for the Community Paramedicine Division of the San Francisco Fire Department. 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 EMS6, 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. We see a lot of people with wounds that they're not getting treatment for. A lot of amputations and stuff. Lots of. I've never seen the amount of amputations like this. This is. It's crazy. The way this system is supposed to work is like a ladder. The bottom rung is EMS6 or a clinician or the police. I reached out to the San Francisco Police Department for the story and didn't get a response. If EMS6 thinks a patient requires involuntary treatment, they take the patient to the hospital. Eddie Byrd, a captain on EMS6, does plenty of this. He spent his whole career on ambulances, which before he worked on EMS 6, made him a pretty popular guy.
- [14:41]
Home Depot Announcer
When somebody's collapsed, you know, 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 us.
- [14:52]
Hanna Rosen
When those types of patients arrive at the hospital, everyone knows what to do. But on EMS 6, it's different.
- [14:59]
Home Depot Announcer
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?
- [15:07]
Hanna Rosen
EMS6 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, but 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 make this expansion work doesn't yet exist in the long term lock facilities meant for involuntary treatment. There is a desperate shortage of staff in 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 to the only place they can go, the emergency department. 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, which leaves Eddie and April and their team trying solutions that feel surreal. April told me one story about a client of theirs that was suicidal. He had told them as much. They kept getting 911 calls reporting that he had walked into traffic. EMS6 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 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.
- [16:45]
Home Depot Announcer
Every day you go out to people that don't want to see you. To people that are calling, that are angry because you're not fixing the problems, because you don't have the tools nor the resources to fix these problems. So, you know, 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.
- [17:02]
Hanna Rosen
Since the adoption of this expanded system 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. 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 Evan up 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.
- [18:03]
Susan Eggman
So this is six in the coma.
- [18:05]
Evan Brooks
Okay, can we go for a walk?
- [18:07]
Hanna Rosen
So Joe Nguyen, Evan's best friend, has flown to San Francisco to find him.
- [18:13]
Susan Eggman
All right, let's look at this cat.
- [18:14]
Evan Brooks
Look, this is my missing poster for Evan.
- [18:16]
Hanna Rosen
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.
- [18:25]
Evan Brooks
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. That's a fun flyer.
- [18:39]
Susan Eggman
Evan's gonna be like, where'd you get that picture? Oh, Liz took it of me.
- [18:42]
Hanna Rosen
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.
- [19:09]
Evan Brooks
So I have a photo of me and Evan side by side. That's what I was gonna use.
- [19:12]
Susan Eggman
I know, but that looks like him. Now your other one's. He's not happy like that.
- [19:24]
Hanna Rosen
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.
- [19:31]
Evan Brooks
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. We're trying to get him to the hospital.
- [19:38]
Hanna Rosen
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.
- [19:48]
Evan Brooks
Thanks, man. If you see him, we'll be real.
- [19:50]
Hanna Rosen
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 Jo, I'm sorry you're going through this without any irony that I could detect what he said.
- [20:15]
Susan Eggman
McAllister operator.
- [20:21]
Evan Brooks
Hey, my name is Joe Nguyen, and I'm trying to find out if my brother is a patient there.
- [20:27]
Hanna Rosen
12 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.
- [20:38]
Susan Eggman
No, I don't say anyone by a name.
- [20:39]
Evan Brooks
Okay, thank you so much for checking. There isn't any way. Well, all right.
- [20:45]
Susan Eggman
Turn right on.
- [20:46]
Evan Brooks
Can I put, like, a callback number?
- [20:50]
Hanna Rosen
The hospitals don't have any record of Evan. Liz and Joe are running out of ideas. And then Joe's phone rings.
- [20:57]
Evan Brooks
Hello, this is Joe.
- [20:59]
Susan Eggman
Are you looking for someone?
- [21:01]
Evan Brooks
Yeah, yeah, I'm looking for Evan.
- [21:04]
Susan Eggman
Are you mobile right now or what?
- [21:06]
Evan Brooks
Oh, yeah, yeah, he's right here on.
- [21:09]
Susan Eggman
Van Nessa Market, man, in front of the donut joint.
- [21:12]
Hanna Rosen
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.
- [21:26]
Home Depot Announcer
Bring in the cavalry.
- [21:29]
Evan Brooks
How are you, babe? Just so you know, about 400 people have flyers with your pictures on it.
- [21:34]
Home Depot Announcer
I saw one of them, and I.
- [21:35]
Hanna Rosen
Was like, what the fuck is that?
- [21:37]
Home Depot Announcer
I was like, that's not real.
- [21:41]
Hanna Rosen
That night, Joe and Evan stay in a Hotel downtown. 48 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 else, 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.
- [22:54]
Home Depot Announcer
So I had this tiny little, like 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.
- [23:03]
Hanna Rosen
He had decided to stay lying down. So instead of getting up, he called out asking for a lighter, but no one helped. Then he had an idea.
- [23:11]
Home Depot Announcer
Two nights before, I had found this empty matchbox. And where I happened to lay down, there was two broken matches on the ground. And I went 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.
- [23:36]
Hanna Rosen
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. How does this sound to your ear when you're saying this stuff?
- [23:51]
Home Depot Announcer
Yeah, I just can't believe that it would. Me going through it. It's like, how have you gotten so low?
- [24:02]
Hanna Rosen
You know, literally lying on the ground.
- [24:06]
Home Depot Announcer
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.
- [24:14]
Hanna Rosen
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.
- [24:24]
Home Depot Announcer
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. Why?
- [24:38]
Hanna Rosen
Why? No. If you had just had the day that you just described. Well, I feel like, yeah, the answer could be, thank God.
- [24:48]
Home Depot Announcer
Just because of, like, the embarrassment of, like, I never wanted to be like this miss, like, this person on a flyer like that, you know, like just my picture all around town like that.
- [25:03]
Hanna Rosen
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. This episode is brought to you by Lifelock. When you visit the doctor, you probably hand over your insurance, your ID and contact details. It's just one of the many places that has your personal info, and if any of them accidentally expose it, you could be at risk for identity theft. LifeLock monitors millions of data points a second. If you become a victim, they'll fix it, guaranteed, or your money back. Save up to 40% your first year@lifelock.com podcast terms apply. 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.
- [26:25]
Evan Brooks
From my perspective, we're in, like, 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, like, just being out there, right? It's really on the table, and I feel like Mexico's the hammer. We swing that hammer, you're gonna make it to 12 months.
- [26:45]
Hanna Rosen
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. 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 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.
- [27:28]
Evan Brooks
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 a business. You can have a job working for me.
- [27:40]
Hanna Rosen
Right out the gate, 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. 48 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.
- [27:58]
Evan Brooks
You'll be in a very good world as soon as you get out of there. Right. And you guaranteed to get there. You will make 12 months if we send you to Mexico.
- [28:07]
Hanna Rosen
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.
- [28:24]
Susan Eggman
Welcome to Twilight Recovery Center. Please press 0 for assistance.
- [28:29]
Hanna Rosen
Twilight Recovery center is one of a constellation of Mexican rehab centers just south of San Diego, catered towards American clientele. Harrison Sidney is the CEO.
- [28:39]
Susan Eggman
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 that it is an impossibility to complete.
- [28:55]
Hanna Rosen
Do you think about your work as conservatorship?
- [28:58]
Susan Eggman
Yes. I'm the guardian at the door. I'm the one that makes it happen.
- [29:05]
Hanna Rosen
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 the judge. At Twilight, all that control falls to Harrison.
- [29:20]
Susan Eggman
When a family member brings me their loved one, I give them the solution. Ultimately, my signature is going to release their loved one. Whether it's a half an hour from the time that they arrive or a year from now.
- [29:34]
Hanna Rosen
They're handing you a really high degree of trust, correct?
- [29:38]
Susan Eggman
That is correct.
- [29:39]
Hanna Rosen
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. Was that a hard decision for you to make to sign away some autonomy?
- [29:59]
Susan Eggman
You know, I'm not gonna lie. I really didn't know that my parents would have full control over it.
- [30:04]
Hanna Rosen
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.
- [30:22]
Susan Eggman
That's all I could think about. Like the first month I was here was going home and getting high. Like, 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's like, no, the fuck you're not. I was like, okay.
- [30:36]
Hanna Rosen
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.
- [30:48]
Susan Eggman
Relapse in rehab in the States, you can't leave, you can't do anything, you can't have a phone. And the nice thing about being here is that we do go out, we do do normal things at this place. It's kind of like almost like a step down from a rehab.
- [31:08]
Hanna Rosen
Oh, that's interesting. Like it feels a bit more free in a way.
- [31:12]
Susan Eggman
Yeah. Even though you're conservative, you have someone over you. Yeah, you feel more free. They give you the idea that you're free, but you're not.
- [31:26]
Hanna Rosen
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. 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.
- [32:36]
Home Depot Announcer
I don't think I'm ready to do that. I could feel like, like in my head I'm like, I'm going to be successful this time, but like I still have like, just like, still a little worried about having doubt. Like, what if I don't though? And then they. All that time and money they spent and it's just like wasted again. And it's like, I didn't want to do that.
- [32:57]
Hanna Rosen
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.
- [33:14]
Evan Brooks
So listen, but 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. Like, literally like, hey, good to see you. Pop a methadone. We get on the plane because we almost did that yesterday, you'd be in Mexico now. And I get like this, 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 and it's more like.
- [33:46]
Home Depot Announcer
If I feel like if I make.
- [33:48]
Evan Brooks
It the year, it's like it's more meaningful if you choose to do it every day, then if we force you, if 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 the plans. Me once, how do you feel about if it doesn't work the next time I see you, we get on a plane, or if you can pull the ripcord ever. But really the agreement, like eyeball to eyeball that I want to make, if it doesn't work, we're going to Mexico. Thoughts? Any reason to say no?
- [34:13]
Home Depot Announcer
I don't have any reason to say no.
- [34:14]
Evan Brooks
All right, so we agree on it. That's your fucking left hand. All right. Sober or Mexico?
- [34:26]
Home Depot Announcer
Sober here and I suffer. Mexican sober, jail.
- [34:29]
Hanna Rosen
Uh huh.
- [34:31]
Home Depot Announcer
I like it.
- [34:33]
Hanna Rosen
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, 30 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. 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 the street is a success. The cost of that success is a bit tough to pin down. There were years of effort and care and failure from Liz and Joe. There's the hospital bill, which is 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. No Easy Fix is produced and reported by me, Ethan Brooks, Edited by Jocelyn Frank and Hanna Rosen. Engineering by Rob Smirciak. Fact checking by Sam Fentress. Special thanks to Natalie Brennan and Nancy Deville. Claudine Abed is the executive producer of Atlantic Audio and Andrea Valdez is our managing editor. Radio Atlantic will be back.