The New York Times gleefully announced April 6 that San Francisco had “sobered up.” The piece by editorial writer German Lopez talks about “West Coast progressivism at its worst.”
From the piece, which praises Mayor Daniel Lurie for cleaning up the streets:
Getting drug users off the streets is not merely to make the city look better. It gives addicts a clear social signal that their drug use, especially in public, is no longer tolerated. That kind of friction could drive some to seek help, as community ambassadors can attest. Everyone else benefits, too, from cleaner, safer and walkable spaces.
Several doctors who are addiction experts disagreed. From letters to the editor:
Mr. Lopez asserts that more forceful intervention and forsaking of harm reduction principles have led to more people getting the help they need. However, since 2023, as law enforcement crackdowns have intensified, the jail population in San Francisco County has nearly doubled. While Mr. Lopez supposes that incarceration can help people overcome addiction, numerous studies have shown dramatic increases in the rates of fatal overdose after release from jail and prison.
Furthermore, although many of the city’s addiction experts and community leaders recognize the importance of harm reduction interventions as part of an evidence-based approach to reduce transmission of H.I.V. and other communicable diseases, I am certain that none would suggest that it exist as an isolated strategy to address the current housing and overdose crisis. … It may be true that San Francisco has had success in decreasing visible homelessness and drug use, but doing so by using forceful intervention harms our city’s most vulnerable inhabitants.
Another, from two doctors:
German Lopez paints a misleading picture, one that points in exactly the wrong policy direction. The emergence of dangerous synthetic drugs like fentanyl has nothing to do with progressivism or harm reduction. In fact, cities with the highest overdose death rates — places like Baltimore, Philadelphia, Louisville, Ky., and Cleveland and Columbus in Ohio — are neither harm reduction leaders nor exemplars of progressive politics. It’s true that the drug crisis is very visible in high-rent cities with more unsheltered homelessness. It’s also true that public drug use should be addressed — but not by arresting people. Instead, cities should invest in affordable, low-barrier housing, increase treatment beds and allow overdose prevention sites. They should also expand lifesaving harm reduction services, as people who use them are five times more likely to enter treatment than people who do not.
Never mind the evidence, though: San Francisco, after several decades, is moving to abandon harm reduction as a principle in its substance use policy.
Harm reduction saves lives. In the long term, with adequate resources, it’s far more effective than incarceration and forced treatment.
The latest move in the direction of punishment, not care: Sup. Matt Dorsey is pushing a measure to require all new city-funded permanent supportive housing to ban the use of illegal drugs. The measure would allow city contractors to evict residents, and send them back out onto the streets, if they used any “illicit” substances.
From the legislation:
“Illicit drug use” means the use of a controlled or regulated substance in a manner that is unlawful under state or federal law, including use without a valid prescription or outside the scope of lawful medical or other legally permitted use, regardless of whether the substance itself may be lawfully possessed or used under other circumstances.
This comes before the Public Safety and Neighborhood Services Committee Thursday/23; it’s co-sponsored by Sups. Bilal Mahmood and Alan Wong.
Mahmood is also sponsoring a measure to allow an “entertainment district” on Upper Fillmore, where people who have stable homes can use their drug of choice (in this case alcohol) freely and openly on the streets.
Many of those same people use “illicit” drugs, like cocaine, ecstasy, and various hallucinogens, on a regular basis in their homes or the clubs they frequent. They are not affected by the Dorsey/Mahmood bill. (The difference between legal and illegal is not always the difference between safe and harmful: Weed, which is pretty benign as these things go, was illegal until fairly recently, and cigarettes, which kill nearly half a million people in the US every year—ten times the number who die from fentanyl—are perfectly legal.)
There’s widespread agreement that the city ought to offer some sober housing for people in recovery. (The city already funds drug-free treatment and housing through grants to the Salvation Army.) But a mandate that all new PSH be drug-free is a path to more homelessness, more overdoses, and more death on the streets.
I asked Dorsey if Dr. Carl Hart, a Columbia professor, should be evicted from his home because he uses heroin. Dorsey:
I couldn’t speak to this individual’s situation, Tim, but in general I think residents of Permanent Supportive Housing should have a drug-free option as an alternative to the drug-tolerant standard if that’s what they choose. There are 240,000 residential leases in San Francisco for which tenants can be evicted for the on-site use of illicit drugs — it’s a standard residential lease provision — but *only* in PSH is there an explicit exception for drug use.
I have never heard of anyone (particularly a wealthy person) getting evicted from a private rental for using drugs, quietly, in their own home. If that were the case, half of the residents of San Francisco would be homeless.
Dorsey:
Drug use absolutely plays a role in residential evictions when it interferes with other tenants’ quiet enjoyment and is deemed severe, continuing, or recurring.
The legislation doesn’t mention severe continuing or recurring. It does say that
a single relapse or instance of illicit drug use may not be treated as an automatic cause for eviction or termination from a program, but that participants be offered relapse support; and
(3) Provide that an operator may seek to terminate a resident’s tenancy when a participant’s behavior substantially disrupts or impacts the welfare of the community in which the participant resides;
So eviction for one strike is not “automatic.” But it’s allowed. The regulations would be drafted by the Mayor’s Office of Homelessness and Supportive Housing, which is run by Lurie, who also opposed harm reduction and Housing First. Supportive housing providers can already evict someone who is disruptive to the community, drug use or not.
I agree that some people want drug-free housing, and that should be an option. But why make it a mandate for all city money, when that option doesn’t work for everyone?
That hearing starts at 10am.
The Budget and Appropriations Committee is holding its early hearings on what will be a bitterly contentious budget process. On Wednesday/26, Sup. Shamann Walton will hold a hearing on on workforce development programs including
potential cuts to workforce training and employment programs that help San Francisco residents get to work, including programming for youth through adults, as well as ambassador programs.
Then Sups. Cheyann Chen and Myrna Melgar have asked for a hearing on
family affordability in San Francisco and the impacts of proposed budget cuts on vulnerable communities, low-income individuals, and immigrant families; the role of community-based programs and services in maintaining housing stability, workforce participation, and access to essential services and the misalignment of current budget decisions with those commitments.
In both cases, the supervisors have asked not only the Mayor’s Office but the People’s Budget Coalition to report. The hearings will start to shed some light on the dramatic impacts, on the ground, in communities, on vulnerable people, of a budget that will prioritize law enforcement—arrests, prosecution, jail—over public services that help prevent crime.
That hearing starts at 1:30pm.
The mayor’s attack on public health will start to emerge at a Health Commission hearing Monday/20, where the department will explain how it plans to cut $45 million out of its budget.
It won’t be pretty.
You can see the outlines here. Some of it sounds almost benign; “retirement savings” without layoffs. But that means when people retired, that job is never filled, so the DPH staff is reduced.
The department is going to close clinics that are “underutilized,” like the Southeast Mission Geriatrics Services, which serves 200 patients in the average year. “Every patient will be offered a seamless transition to another outpatient clinic with no gap in services and will have the option to continue seeing their current health care provider.” The patients, all of them seniors, many likely with mobility issues, will just have to find a way to travel across town to a new clinic. That’s not simple or easy for geriatric patients.
The plan, like the rest of Lurie’s approach, cuts deeply into harm-reduction programs: “Direction from the Mayor’s Office: Harm Reduction services that have negative collateral impacts on our communities should be reevaluated.” That means program that save lives but bother wealthy people and tourists have to go.
A program operated by the AIDS Foundation that cleans up used needles on the streets? Gone. Savings: $414,000, such a small number that it’s hard to even measure as a percentage of the city budget. Another: “Discontinue AHP safer use supply clearinghouse” (clean needle exchange): $580,000.”
More: “Transition outdoor supply distribution at 3 mobile sites in public spaces (SFAF Hemlock, SFAF Duboce, and HRTC Victoria Manalo Draves Park), meaning fewer places to get clean needles: $80,000.
The list goes on.
Much of this pain, suffering, and even death will be unnecessary if the voters approve Prop. D, which would raise $300 million by taxing big corporations with CEOs who make more than 100 times the media wage of the workers.
Mayor Lurie opposes that measure and is working to defeat it.
Five supervisors— Walton; Jackie Fielder, Chen, Connie Chan and Melgar—are sponsoring a resolution “affirming the importance of keeping the independent civilian oversight of the San Francisco Police Commission.” That position is directly contradictory to the Lurie’s Charter reform proposal, which would give the mayor much more direct authority over the cops.
The measure comes up at the full board Tuesday/21. All of Lurie’s allies will vote No–but I will be fascinated to hear their excuses.
