San Francisco Chronicle (SF) - SUNDAY, July 2, 1995 Edition: SUNDAY Section: Sunday Chronicle Page: 2/Z1 Word Count: 968
Maitland Zane, Chronicle Staff Writer

Dr. David E. Smith sees storm clouds ahead. He thinks American health care has become a disaster, and says it's time the Clinton administration admitted the obvious -- the war on drugs is tearing society apart.

"The drug war has failed," Smith said. "It's a racist war, and it's corrupting the system. We need a new policy -- decriminalization."

Smith was having a cup of Sumatra and a sweet roll in a coffee house on Haight Street, a couple of blocks from the funky Victorian house at 409 Clayton Street where he has worked in the same third-floor walkup office since Richard Nixon's first term as president.

His curly hair touched with gray, Smith, 56, says he's proud of his Okie roots in Lindsay, a farm town near Bakersfield. He says coming from a "Grapes of Wrath" family enabled him to identify with society's outsiders.

In June 1967, Doctor Dave was a longhaired Berkeley hotshot who had completed his internship at San Francisco General Hospital. He lived in the Haight and he was appalled at the plight of the tens of thousands of young people who had flocked to San Francisco for what was touted as a Summer of Love. For too many of the flower children, it ended up a bum trip -- with drug problems, rip-offs, crime and sexual exploitation.

With $500 seed money from the late Rev. Leon Harris, then pastor of All Saints Episcopal Church, and $100 of his own money, Smith opened a clinic in an apartment on Clayton Street off Haight and rounded up some volunteers. The San Francisco medical establishment viewed this altruistic effort with horror. "Some of my old teachers told me, `You were such a promising student! Where did you go wrong?' For them, the fact I was treating addicts at all meant that I had dropped out of the mainstream of medicine."

What began on a shoestring -- Smith wasn't sure the clinic would stay open a second month -- has blossomed into a conglomerate with 22 sites around the Bay Area. The clinics offer treatment of AIDS, drug abuse and alcoholism, a women's center, medical care at rock concerts and psychiatric counseling for inmates. Health care is free, with the federal government picking up 80 percent of the $8 million annual budget.

A professor of toxicology at UC San Francisco Medical Center and a world renowned "addictionologist," Smith has had his share of recognition -- he recently was awarded the UCSF Medal.

He's a serious man who sees a new hard-drug crisis in the neighborhood where he lives with his wife, Millicent, and three teenage children. He is outraged that 23 percent of Californians don't have health coverage, and that neither President Clinton nor Republican presidential front-runner Senator Robert Dole seems willing to meet the medical needs of the have-nots. "Dole said recently, `There's no health crisis in this country' -- what planet is he living on?"

Smith said the Free Clinics see 500 patients a day, 10 to 15 percent with the HIV virus, and 50 percent seeking help for drug problems.

"The Haight is a mirror of what's going wrong in society," he said.

"Heroin is on the upswing. Cocaine has stabilized as the No. 1 drug on the street, speed is up by 20 percent, but heroin is up by 40 percent in the last year or so, and it's more potent, it hasn't been diluted as much."

A dangerous "marker," he said, has been the recent upsurge in deaths from drug overdoses in San Francisco. On a recent weekend, eight people died from "speedballs," street slang for a cocktail of heroin and cocaine, or heroin and methamphetamine.

Smith favors decriminalization of drugs, but not legalization. "The criminalization of drugs has failed. Even most law enforcement people agree with this. Our prisons are filled to the rafters with drug abusers. Moreover, it's a racist war that targets blacks and Hispanics.

"If you're white and middle class, they call it a sickness and you get treatment. If you're a black or (Hispanic) addict, they call it a crime and you are jailed."

Prison, he says, is the most expensive but least effective "intervention." He cited a recent California study that showed every dollar the public invests in drug treatment saves $7 in incarceration.

"What we should have is a balanced policy toward all addictive drugs, including alcohol and tobacco," Smith said. "The cocaine war is not going to be won in the jungles of Colombia. It will be won on the streets of the Haight Ashbury by way of education and treatment and revitalization of the community."

Smith said he once had an alcohol problem. He hasn't had a drink since 1966 but he still occasionally attends Alcoholics Anonymous meetings, and still says the AA "serenity prayer" several times a day.

"What has always kept me going all these years is the recovery movement. The bad news is that we have no public policy; health care has become a disaster and Congress has no plan for the uninsured. The good news is a dramatic improvement in our ability to treat addiction. We're having success with `anti-relapse' drugs like Naltrexone. We're learning more about genetics.

"There are thousands of people now in recovery. . . . Early intervention and treatment does work, and it's very cost effective. But society prefers to build prisons. I think we need a new policy."

CAPTION: PHOTO Dr. David Smith stands in the doorway of one of his first free clinics, on Clayton Street, which was opened (and painted) 28 years ago/BY MICHAEL MALONEY/THE CHRONICLE

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