Pima County's new addiction recovery effort needs more than referrals | Opinion

When someone in a substance-related crisis ends up in a jail cell or an emergency room, the system usually manages the moment and moves on. Pima County is trying something different, and the early results deserve attention.

The Sobering Alternative for Recovery (SAFR) Center opened in January as a 24-hour site where police and paramedics can bring people instead of jail. Its 15 beds allow stays of up to 96 hours. In its first three months, it served 138 people, and 96% left with referrals to further care, according to a University of Arizona evaluation. Supervisors have since approved another $2.2 million in opioid settlement funds to keep it open two more years.

That is a promising start, but it is not the finish line. A referral is a recommendation, not an admission. Better follow-up data will be essential to understanding the center's longer-term impact and informing future funding decisions.

As a medical toxicologist, I pay close attention to the days right after stabilization. This period can offer an important opportunity to connect someone with treatment, but it can also carry significant risks. After time without opioids, whether in detox, treatment or jail, tolerance can drop, and returning to a previous dose can lead to overdose.

Medical detox can be an important first step, but withdrawal management alone is not a substitute for comprehensive addiction treatment. The National Institute on Drug Abuse notes that medically managed withdrawal can safely handle acute symptoms but, on its own, rarely leads to lasting change. And no single approach fits everyone.

Some people need medical detox. Some need residential care. Many do well in outpatient treatment, often with medication for opioid or alcohol use disorder. Nearly all benefit from ongoing community support. The University of Arizona team also found that many SAFR patients face homelessness and unemployment, so housing and work matter as much as any clinical service.

Here is what Tucson can do to turn referrals into care.

Measure what happens after the referral. Track, with privacy protections, how many people attend a first appointment within seven days and 30 days, and how many are still engaged at 90 days. Make that reporting a condition of continued funding.

Make the handoff warm. A phone number on a discharge sheet is easy to lose. Book the intake appointment before the person leaves, have a peer recovery specialist or care coordinator make the call with them, and follow up within 48 hours.

Support with transportation. The evaluation already named access to transportation as an area to improve for getting people to SAFR. A ride to the first treatment appointment costs little compared with another crisis.

Match care to need quickly. Use a standardized level-of-care assessment at discharge so referrals fit the person. Give staff real-time information on open detox and residential beds. Where clinically appropriate, start or bridge medication before discharge so there is no gap.

Bring families in and send people home safer. With consent, help families understand the options and the next steps. Ensure patients at risk of opioid overdose have access to naloxone and know how to use it.

A crisis can create an important opportunity to connect someone with treatment. Whether that opportunity leads to ongoing care depends on what is waiting next: an open bed, a scheduled appointment, a ride, or a coordinator who follows up. Tucson’s opioid settlement dollars are limited. Spending them on those connections, and measuring whether people actually reach care, is how Southern Arizona can make sure a crisis becomes a starting point for treatment rather than a pause before the next one.