LOS ANGELES – Inside a locked conference room, the Los Angeles County Department of Health Services and Housing (HSH) held its first quarterly Skid Row Action Plan meeting of 2026. Officials brought slides, statistics and a clear message: the system is working. Skid Row residents’ couldn’t have disagreed more.
Skid Row, formally Central City East, has been ground zero for L.A.’s homelessness crisis since the 1930s, infamous for tent encampments, open drug use and prostitution. Despite over a decade of outreach, transitional beds, and permanent supportive housing, thousands remain unsheltered each year.Even those who get inside often describe chaos that follows them through the doors.
The street noise disappeared once the security door clicked shut. The single room lit by fluorescent lights was cut off from the outside, besides the occasional yelling and pounding heard next door. For two hours, officials presented data and strategies, as residents and nonresidents listened.
But harm reduction quickly lit the fuse.
CRACK ADDICTS AND BUTCHER KNIVES
Harm reduction started in the late 1980s and early 1990s to stop HIV/AIDS from spreading through shared needles when treatment was scarce. By 2016 California made it law: no sobriety requirements for state-funded homeless or addiction services.
The move allowed groups like the Sidewalk Project to hand out drug paraphernalia to cut disease and overdose risks.
County health officials defended the policy Wednesday, saying harm reduction and treatment work together. They pointed to thousands of naloxone kits handed out to reverse overdoses and plans to train “ambassadors” in housing sites.
While officials appeared excited about their efforts and numbers, their faces fell as residents’ began to question the proclaimed accomplishments.
One woman who identified herself as Suzette Shaw, a 13 year Skid Row resident, moved into permanent housing in 2016 after floating between transitional units. She described the permanent housing’s deplorable conditions to the board.
She questioned why transitional housing isn’t prioritized and why people aren’t vetted more before landing in permanent units.
“We’ve got a lot of trafficking going on in our buildings, from drug to sex trafficking to people selling drugs, guns, knives, butcher knives coming out there,” Shaw added. “I have one person who’s texting me right now who has a man up above her who is a crack addict who’s up all night with a family on her floor moving furniture around all night. She can’t get any sleep. Then she has a neighbor next door to her who came after her with a butcher knife.”
“The reason why I ask that question is, as someone who lives in permanent supportive housing, I know the county says it uses the Housing First harm reduction model, but the Housing First model is literally 38 action steps,” Shaw said. “The other county has only implemented 11 of those action steps. Therefore, when people who are chronically homeless are being put in permanent supportive housing with severe mental, behavioral, and drug addiction.”
Some of those sitting near her could be seen nodding their heads in agreement to her statements.
“As we, as a community, living in permanent affordability, people say, ‘Oh, well, go get jobs now. Get a house.’ People say, ‘Well, go prove your life for us. Get a house,’” Shaw said. “We can’t sleep. We have men and people doing harm to us. What’s the focus on getting the drug dealers outside of the community as we’re focusing on the addiction of the community? Why is there not an emphasis? Why do I not ever hear anyone talk about let’s get these drugs and these drug dealers out of our community.”
Before public health officials could speak, Molly Rysman, Housing for Health Director of Policy and Planning, stepped in to respond.
“But what you’re bringing up, I think – and I will also just say from my own personal experience, we are terrible at deciding who’s housing ready,” Rysman said. “I don’t think we want the system to be gatekeepers, to say, ‘Oh, this person’s housing ready. This person’s not housing ready.’”
“My experience is sometimes I see somebody who looks like how could they ever succeed in housing and they do extraordinarily well in housing. And somebody else who had a job and looked like they totally had it. They never completed the whole department and made it to housing,” Rysman added. “We can’t see the future. We can’t predict. So we don’t want to be gatekeepers. We do want to help people get into housing.”
Some studies argue Housing First can increase stability and reduce some substance use in certain programs. Critics though have warned that placing people with active, severe addiction or mental health crises into permanent supportive housing without stronger vetting, on-site treatment requirements or behavioral safeguards can import street-level chaos indoors.
The mixture of the two then creates an unsafe environment for neighbors, with reports of violence, trafficking and limited recovery progress in high-addiction areas like Skid Row.
Rysman’s defense didn’t land with the crowd.
POOKIE PIPES
Another resident identified as Don Garza, who served in the U.S. military and has been in Skid Row for 26 years, pressed the issue, focusing on “pookie pipes.”
Pookie pipes are used for smoking methamphetamine or crack cocaine. They have been distributed in harm reduction kits to reduce risks like lip burns, infections from sharing, and disease transmission such as HIV or hepatitis.
While supporters often argue they prevent overdoses by encouraging safer use, critics say they enable ongoing addiction amid the fentanyl crisis.
“The community wants to know how many pookie pipes have you passed out so that people can be enabled out there to put it in the pipe and overdose on fentanyl?” We watch it every day. I walk out my building, people are dead on the sidewalk. The only person out there that’s doing anything is people like her over there and her over there. We need both of them,” Garza said pointing towards two others who had been sitting amongst the crowd.
“The question is, and I know you want me to be quiet, how many people have you killed with what you’re doing right now? This is not 1986. This is not 1995. This is [2026],” Garza added. “We have a fentanyl epidemic, and you’re so proud of passing out so much naloxone, but you haven’t talked about the pookie pipes. How many people are you killing?”
Specific data on the number of “pookie pipes” distributed in Los Angeles for 2024 or 2025 is not publicly available in detailed breakdowns. But Los Angeles County increased investments in harm reduction services by 500% in 2024, according to the Department of Public Health, which includes supplies like pipes as part of overdose prevention efforts.
Rysman, once again, stepped in to state that she would not be able to have an answer to his concerns immediately.
“So, Don, there’s not going to be an answer to that today, but what I want to say is we appreciate it. We appreciate everything you’re sharing,” Rysman said. “There’s going to be a larger community meeting on harm reduction.”
CYCLICAL CHAOS
The Skid Row Action Plan, backed in part by federal U.S. Department of Housing and Urban Development (HUD) grants that sent more than $200 million to Los Angeles’ Continuum of Care in the fiscal year of 2024, aims to expand housing and services.
But while California keeps pulling in billions from Washington D.C., the state’s homeless count remains the nation’s highest, up 60% since 2015, and audits continue to flag oversight failures in hundreds of millions of HUD funds.
The meeting wrapped with the typical promises: more data, more listening sessions and a follow-up community forum on harm reduction. Officials thanked the room for the feedback, leaving residents’ to go back out into the mayhem they left behind two hours earlier.
Days after the meeting, the Daily Caller News Foundation was told the next scheduled gathering was reportedly cancelled.
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