They call Los Angeles the City of Angels, but it seems that even here, within the five-by-ten-block area of Skid Row, the city contains an entire cosmology—angels and demons, sinners and saints, plagues and treatments.
Walking down San Pedro Street to the heart of Skid Row, I see men smoking methamphetamine in the open air and women selling bootleg cigarettes on top of cardboard boxes. Around the corner, a man makes a drug transaction from the window of a silver sedan, a woman in an American-flag bandana flashes her vagina to onlookers, and a shirtless man in a bleached-blond woman’s wig defecates behind a parked police car. Slumped across the entryway of an old garment business, a shoeless, middle-aged junkie injects heroin into his cracked, bare feet.
Skid Row is the epicenter of L.A.’s addiction crisis. More than 12,000 homeless meth and heroin addicts pass through here each year, with thousands living in the vast network of tent encampments that line the sidewalks. For decades, L.A. has centralized public services in this tiny city-within-a-city. The result: it’s become an iron cage of the social state, with the highest concentration of homelessness, addiction, and overdose deaths in Los Angeles County. Fire Station 9, which covers Skid Row, is now the busiest firehouse in America, responding to 35,518 calls for service last year, including a record-high number of overdoses and mental-health crises.
The scale of the crisis is astonishing: 40,000 homeless men and women in Los Angeles County suffer from addiction, mental illness, or both. More than 1,000 will die on the streets this year. As I survey the human wreckage along Skid Row, my fear is that the city government is creating a new class of “untouchables,” permanently disconnected from the institutions of society. For the past decade, political leaders have relied on two major policies to address the crisis—“harm reduction” and “housing first”—but despite $619 million in spending in 2018, more people are on the streets than ever. The reality is that Los Angeles has adopted a policy of containment: construct enough “supportive housing” to placate the appetites of the social-services bureaucracy, distribute enough needles to prevent an outbreak of plague, and herd enough men and women into places like Skid Row, where they will not disrupt the political fiction that everything is okay.
The LAPD’s Central Police Station is a windowless fortress, surrounded by a narrow strip of dirt and a sagging chain-link fence. Last year, after rats established a system of tunnels underneath the station, the department made plans to pave over the remaining landscape with concrete, but the project is on hold. I’m here to see Sergeant Pete Kouvelis, an LAPD veteran with a detailed, street-level understanding of life on Skid Row. I wait in line behind a polite and neatly dressed man filing a battery complaint against another resident in his SRO apartment complex, and then give my name to the tired-looking officer behind the glass.
After a moment, Sergeant Kouvelis, a broad-shouldered man with a military haircut, opens the security door and shakes my hand. As we pass through the back hallways and climb into his white patrol vehicle, Kouvelis, who earned a degree in architecture from USC and served as an officer in the Marine Corps, launches into a short discourse on the political economy of Skid Row. He says that the territory here is divided into sections by street gangs from South Los Angeles, who control the markets for meth, heroin, prostitution, cigarettes, and stolen goods. “This is pretty much the epicenter in L.A. for maintaining your addictions,” Kouvelis says. “You’ve got the gang element that markets their drugs, and it’s predatory. The more people addicted, the better.”
Indeed, addiction is a booming business here. Based on data from the Center for Harm Reduction and the Office of National Drug Control Policy, I estimate that the sales of meth, heroin, and cocaine on Skid Row add up to a $200 million annual enterprise, fueling a massive black market in everything from stolen bicycle parts to human organs. The LAPD, including its gang and narcotics task forces, has tried to disrupt the drug trade for decades, without much success. “We’ve tried different things, different data,” says Kouvelis. “But the population is very good at learning our tactics and then adapting their behaviors to counter our tactics. . . . It’s almost like a shell game, where we’re trying to do one thing today and then, three months from now, we’ll [need to] try a different tactic.”
Outside San Julian Park, which the Grape Street Crips use as a central distribution point for meth and heroin, Kouvelis stops the car in the middle of the street. He explains that we don’t want to be too close to the subsidized apartment buildings because residents on the upper floors will sometimes throw trash, urine, and feces at the cops below. While we wait for another officer to arrive, Kouvelis tells war stories from his time in the Central Division. He points to a tree around the corner that used to have 50 or so hypodermic needles stabbed into it; addicts would take one out, use it to shoot up, and then stick it back into the cracked bark. He tells me a particularly nightmarish story about a young bipolar woman, kidnapped and held in a subsidized apartment, and then plied with meth, tortured, and raped for more than two months; officers found her unconscious, with her hair ripped out and a half-dozen broken bones. A few years ago, Kouvelis says, officers even learned of a baby living in one of the tents—they cordoned off the entire street and went tent-to-tent until they rescued the child.
When the other officer, a thin, bald-headed man, arrives, we get out of the vehicle and walk through the park to the Green Apple Market on Fifth and Wall. Suddenly, we hear screaming and fighting around the corner. The officers run over and find a heavyset woman with a pit bull accusing a man in a bloody gray shirt of harassing her while she sleeps in her tent. Kouvelis, the bald-headed cop, and other officers from another patrol car break up the fight and scatter the crowd. As he crosses the street, the man in the gray shirt protests that I’m taking pictures, and another man in a black beanie points at me and threatens: “If [the police] wasn’t here, you woulda probably got jumped or knocked out.” The police recognize the man in the gray shirt from a few days earlier, when he was stabbed in the neck and nearly died in the hospital. “He’s not long for this world,” says one of the officers. “He’s going to get himself killed.”
Roughly a decade ago, Skid Row’s future looked more hopeful. In 2006, Police Chief William Bratton and Central Division Commander Andrew Smith implemented a strategy of Broken Windows policing for Skid Row, called the Safer Cities Initiative, which led to a 42 percent reduction in major felonies, 50 percent reduction in overdose and natural deaths, and 75 percent reduction in homicides. “We’ve broken the back of the problem,” said Chief Bratton then, reporting that the overall homeless population had been reduced from 1,876 people to 700 people—an astonishing success. (See “The Reclamation of Skid Row,” Autumn 2007.)
The progress proved short-lived. Arguing that Broken Windows policing “criminalizes homelessness,” activists slowly dismantled the Safer Cities Initiative through civil rights lawsuits and public pressure campaigns. Today, Skid Row’s homeless population is estimated to be at least 2,500 people, and crime has been rising for years.
At the Central Division, a consensus is emerging that it’s only a matter of time before the neighborhood explodes. “I was a Marine officer [and] served overseas,” says Sergeant Kouvelis. “Skid Row rivals anything that I have seen to date . . . in terms of the conditions that people live in.”
Over the past 30 years, activists and political leaders have successfully shifted public policy regarding addiction and disorder away from a so-called punitive model that relies on prohibition, incarceration, and abstinence toward a “harm-reduction” approach that takes widespread drug use as a given and attempts to reduce rates of infection and other negative effects. Mark Casanova, executive director of Homeless Healthcare Los Angeles, has been working with addicts on Skid Row since 1985. His Center for Harm Reduction distributes 2.4 million clean needles to more than 12,000 addicts each year. As I walk through the door to the waiting room, I see a gaunt young man waiting to collect needles, swabs, and fentanyl testing strips. A woman with floral tattoos covering her scabbed-over arms slides a tray of used needles into the metal sharps container. On the wall is a large map of the city, with hundreds of blue pushpins marking each spot where an overdose was reversed with a naloxone inhaler provided by the center.
“Since I’ve been here, so many decades, the percentages of the type of drug users has shifted,” says Casanova. “Right now, about 70 percent of [the homeless drug users on Skid Row] are crystal meth users, or a combo of crystal meth and heroin, crystal meth and cocaine. . . . The remaining percentage is probably about 25 percent heroin, and a fair number of cocaine users.” While having such a high percentage of meth users means fewer fatal overdoses per capita in Los Angeles than in cities with higher rates of heroin addiction, like San Francisco, it also means that service providers here must contend with the unique properties of methamphetamines, which flood the body with dopamine and noradrenaline and can induce psychosis and lead to violent behavior.
The Center for Harm Reduction unquestionably saves lives: its needle exchange reduces the rates of infectious-disease transmission, and its naloxone kits reverse hundreds of overdoses per year. Still, it’s a brutal calculus, measuring overall “harm reduction” against a baseline of worst-case scenarios. And outside this limited framework, no evidence exists that harm reduction reduces overall rates of addiction, crime, and overdose deaths. In fact, despite a steady expansion of harm-reduction services, last year was the deadliest on record for Los Angeles County, with meth-related overdose deaths up more than 1,000 percent from 2008, claiming Skid Row as its epicenter. In the Central Division, crime has increased 59 percent since 2010, with officers responding to 13,122 incidents last year, including 2,698 assaults, 2,453 thefts, and 1,350 car break-ins, a trend doubtless intensified by the addiction crisis.
Harm reduction’s major limitation is that its practitioners lack a viable method for moving addicts into treatment and beyond their addictions. Though the center provided clean needles and supplies to more than 12,000 addicts last year, less than 1 percent voluntarily enrolled themselves in its free outpatient drug-treatment program. “There’s a mysterious element to that moment [when people decide to enter recovery that] all of us that work in treatment would love to be able to understand,” says Lori Kizzia, the center’s addiction specialist. “It’s mysterious in that it’s a part of the human spirit that surfaces. . . . But we really feel like even if it was only one person that we were able to be present for and help them make the changes . . . that would be well worth it.”
The problem, however, is that “changing one life” is not an adequate standard for a public-policy agenda. As I watch Casanova and Kizzia walk through the clinic, I’m touched by the kindnesses that they perform for the desperate and disordered people who walk through their doors. But I can’t escape the conclusion that harm reduction will never be enough. The people working here—the administrators, the addiction counselors, the medical teams—are making heroic efforts to keep people alive, but no one has figured out how to reduce addiction and fundamentally alter the trajectory of life on Skid Row.
Three blocks from Skid Row, I follow a small flock of public workers across North Main Street from the art deco–style City Hall—where addicts sleep on the front lawn—to the modernist-style City Hall East. Signs posted on the side of the building announce an upcoming cleanup. Earlier this year, investigators from the California Division of Occupational Safety and Health fined the facility’s administrators for exposing workers to trash, bodily fluids, and a rat infestation that left one deputy city attorney with a typhus infection.
None of this seems to deter Los Angeles mayor Eric Garcetti, who projects relentless optimism and insists that homelessness is primarily a housing problem. The centerpiece of the mayor’s plan—endorsed by activists, unions, and the Democratic establishment—is the construction of new subsidized and permanent supportive-housing units. In 2016, Los Angeles voters approved Proposition HHH, authorizing $1.2 billion in new spending, with the goal of constructing 10,000 units of “affordable housing” over the following decade.
Nearly three years later, the city has finished only 72 units, costing $690,692 apiece, a cost inflation that the city comptroller has called “utterly unacceptable.” In total, Los Angeles spent a total of $619 million on homelessness last year—more than double the previous year’s budget—but the number of people on the streets rose by 16 percent. Regardless, in his most recent State of the City address, Garcetti boasted that Los Angeles has “nearly $5 billion to spend on our work” and that, “based on the evidence, the money that’s been invested, the new hires that have just been made, the time we’ve dedicated, I know that things will turn around.” He blamed the lack of progress on delays in “getting the machinery going” but promised that “in this coming year, we will start seeing a difference on our sidewalks and in our communities.”
Progressives have rallied around the slogan “Housing First” but don’t confront the deeper question: And then what? It’s important to understand that, even on Skid Row, approximately 70 percent of the poor, addicted, disabled, and mentally ill residents are already housed in the neighborhood’s dense network of permanent supportive-housing units, nonprofit developments, emergency shelters, Section 8 apartments, and SRO hotels. When I toured the area with Richard Copley, a former homeless addict who now works security at the Midnight Mission, he explained that when he was in the depths of his methamphetamine addiction, he had a hotel room but chose to spend the night in his tent on the streets to be “closer to the action.” Copley now lives in an SRO unit at the Ward Hotel—which he calls the “mental ward”—where he says there are frequent fights and drugs available at all hours of the day. Even worse, as a condition of receiving federal money, many of the permanent supportive-housing projects must allow residents to use alcohol and drugs on the premises. In recent years, overdose deaths in subsidized homeless housing have been an all-too-frequent occurrence.
The truth is that homelessness is not primarily a housing problem but a human one. Mayors, developers, and service providers want to cut ribbons in front of new residential towers, but the real challenge is not just to build new apartment units but to rebuild the human beings who live inside them. Unfortunately, this isn’t the kind of work that can be “scaled” like a product. Still, the builders have prevailed. Every few weeks, Mayor Garcetti and a rotating group of public officials announce new projects, shovel dirt, and cut ribbons. On Skid Row, a nonprofit developer is building two permanent supportive-housing projects, the Flor 401 Lofts and Six Four Nine Lofts, that will provide studio apartments to 153 homeless men and women, at a cost of $65 million. Though Skid Row is undoubtedly one of the most difficult places in America to achieve sobriety and reclaim a normal life, the city’s political class continues to centralize the problem.
This is the iron grip of homelessness, addiction, and mental illness in Los Angeles: you can’t arrest your way out, you can’t harm-reduce your way out, and you can’t build your way out. Beneath the optimistic rhetoric of the politicians lies growing anxiety that the crisis has moved beyond its control. “This is a FEMA-like, Red Cross–like disaster,” says Andy Bales, a critic of the Housing First model who has spent the last year calling for the National Guard to intervene and help prevent the outbreak of an epidemic. “We have actually left homelessness to grow exponentially to the point that it has put all of us in danger.”
Tonight, from the beaches of Venice to the desert towns of Palmdale, more than 59,000 human beings will sleep in tents, cars, and emergency shelters throughout L.A. County. Here, at the corner of Sixth and Wall on Skid Row, a truckful of sanitation workers in yellow vests passes through the streets with water hoses and spray-buckets of bleach, dousing the sidewalks in the hopes of forestalling the next outbreak of typhus, plague, tuberculosis, or leprosy. Fear grows that the next pile of trash or blood-covered rag will set off an epidemic.
It’s dusk, and the Midnight Mission’s Copley, my guide through the encampments, is getting nervous. He says that we should start heading back because “statistically, we’re likely to get in trouble on this block after dark.” As the streets begin to stir, I find myself looking through the gaps between the downtown skyscrapers, catching a glimpse of the bone-dry hills that surround the city. It strikes me that underneath the steel and stone, this place is a wide-open desert that couldn’t support much life for the first million years of its existence.
At the corner of San Pedro and Sixth, I watch the sun vanish behind the buildings, casting a heavenly glow over the streets and the tents and the worried faces. In the falling darkness, a middle-aged black man with light-colored eyes reaches for my hand. He introduces himself as the Reverend and, bowing to reveal a long surgical scar down the back of his head, tells me that he has broken his neck twice but still walks the streets of Skid Row.
“You’re lucky,” I tell him.
“Luck’s got nothing to do with it,” the Reverend fires back. “From Genesis to Revelation, you won’t see the word ‘luck’ once. It’s God working miracles. He’s going to work a miracle here, too,” he says, spreading his arms the length of San Pedro Street, as if to gather up all its despair into his hands.
The Reverend is mad, it seems, but perhaps no madder than the policymakers who have spent billions in vain, refusing to admit that their proposed solutions have worsened the problem instead of ameliorated it. At least the Reverend seems to understand what the policymakers won’t: that the people on Skid Row are the casualties, not of capitalism or an unfair social system, but of a profound spiritual crisis. Political leaders will continue to make plans, cut ribbons, and wish for luck, but until that reality is recognized and addressed, miracles may be the only thing that works.
Originally Published at City Journal.