Yeah. Ill just add to that, and ill channel kristin marshall, maybe, from the d. O. P. E. Project, that its connected to income inequality, its connected to homelessness, its connected to racism, its connected to sort of our punitive system around substance use, so i think if we can make advancements in those areas, as well, that well see reductions in Overdose Deaths. Supervisor haney thank you. Again, i dont want to take this out all on you, but the frustration, i hope you can understand my frustration. These are people who i represent largely. Theyre dying, theyre dying at rates weve senever seen, and seems theyre going to continue to die at higher and higher rates, and we need to understand how we can save them. We cannot help them, we cannot do anything for anyone if theyre no longer with us. I appreciate and i understand your work, but as a policy maker who represents all of these folks and their friends and their families and their neighbors, i think that we need to have a more comprehensive plan here to to prevent these overdoses, and all of these things are good, but its im having a hard time feeling like its coming together in the sort of coordinated comprehensive plan that we would need to feel confident that we are moving in a different direction. I have a number of questions about the s. R. O. Program, and also around referrals to to treatment and how we are doing that, but im going to pause my questioning. I see supervisor stefani, so im going to different different. Supervisor mandelman yeah, and before we allow vice chair stefani to speak, i have one last question, and i have a housekeeping matter for my Committee Members. I am on the t. A. , which begins at 1 00, so it seems highly likely to me that this is going to go past 1 00, at which point vice chair stefani, you would become the chair of the committee. Im making sure that is okay with you. Supervisor stefani yes, thats okay. Chair mandelman and what the things that will need to happen at that point are, you know, any further questions, comments from Committee Members at this hearing. And then, theres one more item on the agenda, which is a hearing on sb 1045. But because of the covid surge, and that this is probably not the right moment to haul dr. Colfax in and yell at him about s. B. 1045, and the failure to implement that, i think we should continue that until after the current surge, and i so i would ask the committee, when we get to that point, to consider a motion to to continue it until continue that hearing until february 11, which of course, we would have to take Public Comment on, as well, just on that continuance. Does that and clerk carroll looks like he wants to interject on that, as well. Clerk the hearing item number 5 has not been called. If you want me to, i can call that, and you can discuss your comportment on it, as well. Chair mandelman well, i think ive said everything i want to say on that. I just want to make sure that supervisor stefani is ready to take over the agenda. Supervisor stefani im ready, chair. Chair mandelman this is a fascinating hearing, and i feel, like, supervisor haney and i, like, sort of move around these issues and sort of parallel and sometimes intersecting and often experiencing similar frustrations. I dont know if this is where hes going, but its paradoxical and frustrating to me that a city that prides itself on its Public Health orientation and Public Health response that has such great sfrist indication on Harm Reduction and that sophistication on Harm Reduction and that holds itself up as a leadership on Substance Abuse treatment, there is a paradox of having hundreds and hundreds and hundreds of Overdose Deaths which are not thousands and thousands apparently only because were giving out narcan like candy and, you know, have this have narcan everywhere and of course, it is better to be giving out narcan than having people died, but i am perplexed that we seem to have developed this robust comprehensive Harm Reduction approach that seems to be resulting in so much failure and it is totally possible that these two things are coincidental, and that the harm could be so much worse. I know that there are people out there in the public, and i think we have the obligation to explain to them that that the that the that statistics, like the statics around death overdoses are not a result of our sophisticated Harm Reduction approach. Im not saying that it is, but i know there are people out there that believe it is. And just one other a question that i sort of thought of was do we as a public i mean, as a Public Health matter, we all know that we are trying to reduce covid in the city and county of San Francisco. As a Public Health matter, are we trying to reduce active Substance Abuse disorder in the city and county of San Francisco . I understand that we are trying to pursue Harm Reduction strategies, but is it a goal of our Public Health response to have fewer people using substances that may kill them . Absolutely. So our goal is to reduce the overdose increases and to reduce the disparity of those increases; to increase people who are in treatment for opioid, and to keep them in treatment for at least six months, and make sure that theres equitable and plentiful distribution of naloxone. And right now, in our response team, were looking at and we have detailed proposals from our contracting partners, from primary care, from whole person integrated housing. Were looking at 19, and most of them are in the form of expansion of what we do already. Theyve been proven in other cities where theyre having managers like buprenorphine, and then, theres other things that we need programs to do them, things like safe places for people to use while under supervision, so thats the way that weve laid out our plan. So we hope its a fiveyear plan, wibut to kick in, we do need some funding. Chair mandelman and the view is, just to put a final point on it, if we knew what we were doing, we would have better results. Yes. Its deemed that high risk people that weve treated with Harm Reduction to now. Its almost some somebody has in a locks almost as if somebody has naloxone [inaudible] is completely different than when i was trained in 2002. Chair mandelman all right. Things have changed. Its not as dramatic, but because were doing so many good things, a lot of it is expansion, and thats to our advantage. A lot of it is going to be contracting with our partners. And, supervisor, mandelman, i think you just highlighted the problem of he diction. What was it at that point that made you just say im done and make that lifestyle change . And like most things, like, one model does not work for everyone, and thats what makes it just so hard, and i think we just have to acknowledge that thats why its so important maybe we need to do a better job of our framing of what Harm Reduction is because it really is the continuum. I said this before, but, like, many of the people that work on the our Syringe Programs may their Harm Reductionist at work, and in their personal life, they may have their own views on recovery, and we have to just really just engage in that dialogue. I mean, certainly, if someone is at a place where theyre, like, i am done, no, heres some supplies. Cool, lets go. A friend of mine said when he was ready to make that change, he went to the syringe site at 16 and mission and said to the staff that are working there, i am done, and they helped him get into walden house. Im dating myself, but its a complex issue that requires many strategies. Chair mandelman well, thank you all. Thank you, supervisor haney, for bringing us this message. Im sorry that i cant stick around, but i want to thank d. P. H. And all of our Service Providers who are doing this heartbreaking work every day. With that, vice chair stefani, you are in charge, and you are in the queue. Supervisor stefani thank you, chair mandelman, and supervisor haney, are you okay with me asking some questions at this point . Supervisor haney yeah. I have more at this point, but ill jump in at this point. Supervisor stefani theyre more high level, and i love the discussion just in terms of supervisor mandelmans question. And in Harm Reduction, i want to mention that im having a hearing on basically what you just said what does it take from a recovering addicts perspective in terms of what helped them get clean and sober. Thats not making a judgment, thats the only way to deal with addiction and overdose, but i think its not clear to me what exactly are the pathways to recovery abstinencebased recovery in San Francisco . And like i said, its one of many ways to deal with addiction, but i am just wondering if Overdose Prevention includes and has a plan to actually figure out what those pathways to recovery are . Supervisor haney started this conversation by saying, what do you need from us, what do we need to do . Fentanyl is a whole other issue. Just what are we doing to increase those pathways to recovery . Can i ask supervisor stefani, when we use medications to help people, we define abstinence as being on a medication and taking it as prescribed. We have almost 6,000 people who are abstinent in the city because theyre on maintenance medication. Supervisor stefani okay. If theyre on maintenance medication, one would assume there wouldnt be an overdouse resulting from that. And if you think there are people on maintenance medications that could still have overdose, and that would be and die because of it, it seems like another intervention would be necessary rather than just maintenance medication. So if theres 6,000 people who are on maintenance medication that arent in danger of overdosing, thats great, but if theres 6,000