On a recent Wednesday afternoon, alcohol and drug counselor Paulette Mendoza and her teammates load up their van with backpacks and boxes full of supplies before heading out to a familiar spot in Downtown San Diego. As expected, when they arrive, about a dozen people they’ve worked with before are hanging out in front of the discount store.
Mendoza is part of San Diego’s first street health program, launched by Father Joe’s Villages in 2019. They park in the lot and start talking to people.
“A big part of my job is going to be the harm reduction,” Mendoza said. “The amount of time that I spend out in the streets planting the seeds, talking.”
Outreach teams make multiple trips a week to plant the seeds with unhoused residents, meeting them where they are. They treat wounds, address substance use, and respond to severe mental illness with street psychiatry sessions. Since 2020, the program has served more than 3,000 people according to Father Joe’s Villages.
“The deaths are down. People are making it,” Mendoza said. “There’s a lot of things that contribute to that. But probably the biggest one has to be the Narcan cause it’s a game changer.”
Narcan is the brand name for the overdose-reversing medication, naloxone. In order to get it into the hands of people who use drugs, the street health team includes other supplies in their harm reduction kits to help start conversations and build trust.
“We have foil, we have straws. A lot of people are on fentanyl here. We also have a tourniquet. And testing strips for fentanyl and xylazine,” Mendoza explained.
An executive order President Donald Trump signed in late July restricts how federal funding can be used by harm reduction programs nationwide. It directs the Substance Abuse and Mental Health Services Administration (SAMHSA) to stop paying for things like syringes and pipes, targeting efforts some policymakers say “facilitate illegal drug use.”
That afternoon, Mendoza runs into Bakari Rivera, someone she met last year. She counts him as a success story.
“He kinda of looked like the rest of these guys when I met him. He didn’t look good. Like it was a year in the making but like it works if we’re out there,” she said.
Rivera is now a year into recovery and has completed a peer support specialist certificate. He says programs like Mendoza’s made that possible.
“I was down bad when I met her. I didn't have a stable place to rest my head,” said Rivera. “I actually overdosed on fentanyl on accident and flatlined. They gave me Narcan at the hospital and brought me back,” Rivera said.
At their second stop they run into Angelica Preciado, another San Diegan in recovery. She remembers her life before sobriety.
“I was on drugs, alcohol, stealing from stores, hanging out with gang members, I did prostitution,” she said.
Today she’s two years sober, and she and Mendoza support each other at recovery meetings.
But Preciado has mixed feelings about harm reduction supplies, even though she's saved lives with Narcan herself.
“I don't want to sound like a hater or anything like that. I just think that people are giving too many options to people that are addicts,” she said. “You’re giving them a way out. ‘Here, let me give you a bag with clean syringes and everything else, and let me give you some of this Narcan just in case,’ you know.”
Research shows harm reduction doesn’t fuel increased drug use. It reduces disease risk and connects people to treatment. In San Diego County, overdoses dropped from 1,203 in 2023 to 945 in 2024.
“And I believe that is a direct correlation to the harm reduction interventions that were being provided in the community,” said Jenni Wilkens, who manages Father Joe’s street health program.
Her team has already distributed 2,500 doses of naloxone this year, she said. Demand for their help from the street health team rose 15% over the last year, with 176 more people receiving services, Father’s Joe’s data show.
Wilkens is still trying to figure out what the restrictions mean for how the street health team can spend federal dollars but she believes they will erase years of progress.
“We rely so heavily on federal funding and grants, especially from SAMHSA, to equip us with the harm reduction tools that we need,” Wilkens said. “Moving funding away from harm reduction interventions is going to absolutely increase preventable overdose deaths.”
Back on the street, Mendoza said she knows what’s at stake.
“I think there's a stigma that people on drugs are not worth it. But they are,” she said. “You're fighting against the solution. We found something that works, and then they want to defund it. It doesn't make sense.”
By the end of the day, the team handed out 30 kits, offered detox referrals and built connections. Small moments of trust that Mendoza says can lead people to treatment. The same chance that saved her life.
“I’ve died, so every single thing that I do is a blessing that I couldn’t have done had somebody not brought me back,” she said.
Every kit, every conversation, she said, is a seed. Without certain tools, that chance for change could vanish.
