They call Los Angeles the City of Angels, but it seems that even here, within the five-by-10-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 LA’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, LA 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 emergencies.

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 OK.

Roughly a decade ago, Skid Row’s future looked more hopeful. In 2006, then-LA ­Police Chief Bill Bratton and LAPD 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, a 50 percent reduction in overdose deaths, and a 75 percent reduction in homicides.

“We’ve broken the back of the problem,” Bratton said at the time, reporting that the overall homeless population had been reduced from 1,876 people to 700 people — an astonishing success.

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 LAPD’s Central Police Station, 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 LAPD veteran Sgt. Pete Kouvelis. “Skid Row rivals anything that I have seen to date … in terms of the conditions that people live in.”

He says that Skid Row territory 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 LA 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.”

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, and moved toward a “harm-reduction” approach that takes widespread drug use as a given and attempts to reduce rates of infection and other negative effects.

‘This is pretty much the epicenter in LA for maintaining your addictions.’

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, LA 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 $619 million on homelessness in 2019 — 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 ­haven’t confronted 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 single-room-occupancy 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 are 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 a 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.”

Adapted with permission from City Journal