By MARIJKE ROWLAND
San Joaquin County leaders are asking voters to weigh in one of the oldest public policy questions: Which works better, the carrot or the stick?
A ballot initiative on the Nov. 5 ballot, if passed, would require people suspected of substance abuse who receive public benefits to undergo mandatory drug screening and treatment.
If successful, similar initiatives could spread to other areas of the Valley. Measure R would end cash assistance to people who refuse treatment across the county.
The movement to require drug testing and treatment to receive taxpayer-funded benefits is not new. Similar policies have been debated for decades and were bolstered in the 1990s by then President Bill Clinton’s welfare reform platform.
But over the years, some mental health experts and addiction researchers have argued that punishment – the so-called “stick” of taking away cash assistance and other public aid – is not the most effective or cost effective way to motivate people with substance-use disorders to change.
In California, the punishment approach has recently taken hold in surprising places.
In March, voters in famously progressive San Francisco overwhelmingly approved Measure F, a drug-screening and mandatory treatment initiative that, like San Joaquin County’s ballot measure, kicks people who refuse treatment off the public rolls.
After the measure passed by 58%, supervisors in San Joaquin County were encouraged to consider a similar initiative.
San Joaquin County District 3 Supervisor Tom Patti, who authored and introduced the initiative, said he modeled his plan on the San Francisco policy.
His measure was passed unanimously by his fellow supervisors. Patti hopes to spread the approach across the region and encourage supervisors from other counties to draft similar plans.
“I think the biggest key is that we want to have regional continuity,” he said. “I've spoken with supervisors in Stanislaus County and Sacramento County. I'll be talking with supervisors in Yolo and Alameda and Contra Costa that all regionally touch each other in some capacity or another. And if there's, again, that continuity, then I think we can really lead the way for the state to demonstrate how we can engage (in combating the drug crisis).”
Measure R would affect San Joaquin County’s poorest residents.
About 400 people a month receive general assistance, which goes to “indigent residents” who do not qualify for other benefits programs.
Eligible recipients receive $75 a month in cash which goes to their EBT cards. Those approved for housing assistance receive a maximum of $340 in rental support, which goes directly to the landlord, and $27 monthly on their EBT card.
If approved, the new drug screening measure would test recipients suspected of having substance-abuse disorders.
Those found to be using illegal drugs would then be offered placement in free treatment programs.
People who failed to comply with treatment could lose their general assistance aid.
Alcohol and cannabis use are not covered in the ballot measure because the recreational use of both is legal in the state.
Most of the current general assistance recipients, some 75% or about 300 of the 400 total, receive only the $75 a month from the county. Measure R would apply only to single, childless recipients of the public aid who are under the age of 65 – the majority of whom are unhoused men.
Measure R would likely be a pricey proposition. Without factoring in the cost of operation, including the need to hire more staff who would administer the policy, the one-time cost to place the measure on the ballot will equal, or possibly double, the general assistance program’s annual budget of about $300,000.
The total cost to run the screening and treatment programs, which would be run in partnership between the county’s Human Services Agency (which administers general assistance) and Behavioral Health Services (which administers treatment options), is currently unknown.
But San Joaquin County Behavioral Health Services Director Genevieve Valentine has already informed supervisors that, were the measure passed by voters, the agency would not be able to implement the policy by its Jan. 2, 2025 start date.
Instead, she estimated, it would be about a year from now before the agency would have it up and running.
The county would need to establish a new testing program, which would require the hiring of at least three additional staff, Valentine said.
Health Services Agency Director Chris Woods said a survey of his staff suggested that anywhere from five to 10 people receiving general assistance each month could be screened and require treatment. That could amount to an additional 60 to 120 screening referrals each year going to Behavioral Health.
Woods said his agency would likely also need to “ramp up” staffing, though not by as much as Behavioral Health. The general assistance program currently has a staff of 26 people in the county. HSA workers would oversee the “reasonable suspicion assessment” for those referred to drug screening under the measure. Then BHS staff would oversee the required treatment.
Supporters of Measure R argue that the cost of implementing screening and mandatory treatment programs doesn’t matter as long as they help people get off drugs. Patti said he is in favor of any way to “incentivize (people) and then help save their lives.”
But some mental health professionals and addiction specialists say there is insufficient evidence that punitive policies that cut off welfare benefits are the best way to get people off of drugs and into treatment.
“There are no convincing studies showing some state or county has reaped great financial reward or caused a bunch of poor people to enter recovery (from these kinds of policies),” said Stanford University Psychiatry and Behavioral Sciences Professor Keith Humphreys, a longtime researcher of addiction policy and treatment. “I mean, there's literally not a single convincing evaluation….If you put the burden of proof on the people who are proposing this, ‘Show me where this worked really well?’ I'm not aware of any place that can have that data. And these (kinds of policies) have been tried a lot.”
Some argue that is the true intent of policies like Measure R – to have fewer poor people receive taxpayer-funded public benefits. Laura Guzman, the Executive Director of the National Harm Reduction Coalition, said the region’s embrace of 30-year-old drug policies is regressive and disappointing.
Her organization advocates for evidence-based drug policies which minimize the negative impacts of illicit drug use. The harm-reduction movement includes efforts such as clean needle exchanges, safe consumption sites and easier access to overdose prevention medication like Naloxone.
“In some ways I think we have this dystopian (idea) that by somehow further punishing the people who (use drugs) we will be safer,” Guzman said. “But the more we cut benefits, the more the most vulnerable people will be in danger. Destroying the safety net does not gain us anything.”
Marijke Rowland is the senior health equity reporter for the Central Valley Journalism Collaborative, a nonprofit newsroom which publishes The Merced Focus, in collaboration with the California Health Care Foundation (CHCF)
