Marcos Bretón

This homeless woman used to panhandle outside Tower Cafe. A new treatment has given her hope

Less than three years ago, Ashley Kearney was sleeping on a sheet of cardboard outside the Tower Theater in Sacramento. She would spend her days panhandling outside the theater and the adjacent Tower Cafe, trying to acquire enough cash to feed her addiction to heroin.

“I learned how to panhandle by holding a sign on the side of the freeway,” said Kearney, now 31. “I would make my sign by pulling a piece of cardboard out of a dumpster. I’d make $20.”

Then she would use the money to get high and start over again.

“I really thought I was going to die like that.”

Like so many homeless people in Sacramento, Kearney had a life before addiction deposited her on our streets. She was a high school graduate. She had gone through cosmetology school. Her family owned a ranch with horses. She had relationships, ambitions. She and her mother were best friends. She was working full time at Whole Foods, had started a 401(k) retirement fund.

It was all upended after the first time she tried heroin, at the suggestion of her then boyfriend when she was 23.

“He was high and it seemed kind of attractive,” she said. Her boyfriend had described his high as “getting a hug from God.”


“I asked, ‘Can I try it?” She did. “I was instantly addicted. I became a different person. I quit my job that I had for over five years. I cashed out all my paid time off. Everything I had saved up I cashed out.”

Kearney also cashed out on every relationship she’d had. All her personal life lines were severed after one needle injection, and the fall that she experienced dumped her onto that piece of cardboard outside the Tower Theater. It dumped her on trash bins behind the Safeway at 19th Street and on the corner of Third and Broadway and on midtown freeway off-ramps.

“I couldn’t balance a relationship with anything or anybody other than the drug,” she said.

Sacramento Supervisor Serna steps in

I’d bet money that I walked past Kearney without even looking in her direction at least once. Maybe you did as well?

One person who didn’t look away was Sacramento County Supervisor Phil Serna. In January of 2017, on the night city and county officials participated in a federally mandated count of homeless people known as a Point in Time count, Serna struck up a conversation with Kearney outside Tower Cafe.

“He asked me why I was homeless. What brought me to this place,” Kearney said. “I said, ‘I’m addicted to opiates and I can’t stop.’ I started crying. It was winter. It was cold. It was a sad time.”

Kearney couldn’t know it then, but her meeting with Serna opened a path to get her off the streets and return to the life she knew. And the question is whether that path might help even more homeless people get off Sacramento streets.

Like many elected politicians in California, Serna’s job had become consumed by dealing with the effects of homelessness by the time he met Kearney. He struggled with how to help or what to do until he met Neil Flynn, an illustrious doctor in Sacramento who helped start the HIV clinic at UC Davis in the early 1980s, at the dawn of the AIDS epidemic.

Flynn had treated patients with HIV for decades and was a professor of clinical medicine at UCD for many years. But now he was fully dedicated to a small clinic in Oak Park that treated people with opioid addictions.

Dr. Neil Flynn stands at the entrance to the Transitions Buprenorphine Clinic on Aug. 23, 2019. The small clinic in Oak Park is dedicated to treating people with opioid addictions. Lezlie Sterling

The drug used to treat opioid addicts at the Transitions Clinic on 40th Street is buprenorphine, which was only approved for clinical use by the federal government in 2002. The federal Substance Abuse and Mental Health Services Association describes buprenorphine this way: “Unlike methadone treatment, which must be performed in a highly structured clinic, buprenorphine is the first medication to treat opioid dependency that is permitted to be prescribed or dispensed in physician offices, significantly increasing treatment access.”

For Kearney, buprenorphine got her off the street. It quelled her addiction for heroin. It did away with the diarrhea, the aching bones and muscles, the tremors and the insatiable urge to use heroin again.

“People return to their normal selves as if they have never been addicted in the first place (by using buprenorphine),” Flynn said. “As long as they take their meds, that’s the way they remain.”

Some skeptical of buprenorphine

Flynn said his clinic has 600 patients, including many successful people. “We have ophthalmologists who perform cataract surgery. We have firemen, active duty military,” Flynn said. The doctor also has patients who drive an hour or more to see him.

“We could fill a bus from Auburn and Placerville,” he said. Why? Flynn said a lot of doctors struggle with the perception of treating an opioid with a partial opioid, so they shy away from buprenorphine.

“The general public feels that heroin users are scumbags,” Flynn said. That thinking influences doctors as well, he said.

The truth is that opioid use cuts across socioeconomic classes. The truth is that opioid use fuels our homeless crisis. The truth is that Kearney came from a “good family” and still ended up addicted and an even larger truth is that the backgrounds of addicted people shouldn’t matter.

Kearney tried methadone and it didn’t work for her in part because she would still feel as sick on methadone as she did on heroin. As a patient at Flynn’s clinic, she feels whole and by feeling whole, she is a functioning member of society again.

Flynn and Serna are trying to expand the reach of buprenorphine in this region. Serna got the Sacramento County Health Clinic to dispense buprenorphine in a pilot program he said he hopes will become permanent next year, when he is the chairman of the county Board of Supervisors. Flynn is fighting with insurance companies to cover buprenorphine more widely.

“What makes buprenorphine different is that you have less withdrawal symptoms and it addresses the cravings,” Serna said. “Because this crisis is so acute, I feel responsible to spread the news.”

Both Serna and Kearney have had even happier news to spread lately: Kearney is pregnant.

‘It’s a girl!,” Kearney said in a recent interview. “She is due on Nov . 22.” Kearney met a man who was also in recovery and they are building a life together. She has a job, has reconnected with her family.

“I never thought I would have these experiences,” she said. Flynn said his patients, like Kearney, will use buprenorphine for the rest of their lives. If they stop, their cravings for opioid use would return. We need to get over that, he said. Societal expectations of abstinence are outdated. “It’s like holding your breath under water. No matter how hard you try, the body needs oxygen.”

As our homeless epidemic grows, the work that Flynn and Serna are doing takes on a greater significance. Kearney is proof that you can get people off the street with the right treatment. So why not make it more available throughout the region?

“In the last nine years, the number of people addicted to opioids has gone off the charts,” Serna said. “If we have something that is effective, then we should be held accountable if we don’t pursue those effective treatments.”

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Marcos Breton writes commentary and opinion columns about the Sacramento region, California and the United States. He’s been a California newspaperman for more than 30 years. He’s a graduate of San Jose State University, a voter for the Baseball Hall of Fame and the proud son of Mexican immigrants.