San Francisco’s ambitious plan to tackle the growing drug crisis

A trio of San Francisco supervisors revealed an ambitious citywide road map Tuesday to tackle drug overdose deaths, addiction and open-air use and dealing, urging a coordinated response that uses millions from opioid lawsuit settlements to address an unprecedented crisis.

The guiding document, which includes recommendations and directs city departments to report back with solutions, follows a devastating two and a half years. Since the start of 2020, the city has seen nearly 1,700 fatal overdoses, almost double the death toll in the COVID-19 pandemic.

Resident complaints about drug activity reached a fever pitch last year, prompting Mayor London Breed to declare a controversial three-month emergency in the hard-hit Tenderloin neighborhood. Breed’s tenderloin emergency and her ongoing initiative have failed so far to transform the neighborhood, putting additional pressure on supervisors to deliver citywide solutions.

Supervisor Matt Dorsey, who is in recovery from drug and alcohol addiction, announced the launch of the “San Francisco Recovers” plan at the recovery and employment program Delancey Street Foundation Tuesday morning alongside colleagues Rafael Mandelman and Catherine Stefani. All three are allies of Breed, who appointed Dorsey, a former police spokesman, as supervisor in May.

Dorsey, who is running to retain his seat in November, announced earlier this summer that he was working on a “Right to Recover” plan that would tackle the crisis. One part of that plan would be direct police officers to prioritize arresting drug dealers and confiscating illegal drugs from users in areas where people are seeking help with addiction, such as outside a detox facility.

“San Franciscans are demanding solutions as big as our problems, and none of the problems facing our city right now are more visible, more destructive, or more deadly than rampant drug scenes, street-level drug dealing and fatal overdoses,” Dorsey said in the courtyard of the residential building along the Embarcadero.

Dorsey’s efforts are not unprecedented. Former Supervisor Matt Haney sponsored a resolution that required the health department to come back with a plan on how to address the overdose public health crisis, and they did, but the problem was implementation, he said. Supervisor Dean Preston already called for an overdose prevention plan hearing on Sept. 29 in anticipation of the city closing its Tenderloin drop-in center in UN Plaza where people have been allowed to use drugs.

When asked why past efforts had failed so far — and how his plan would be different — Dorsey told The Chronicle the city’s approach has been a “political failure before it’s any other kind of failure.”

Dorsey cited a study that found European cities that reduced open-air drug scenes had “political consensus” around the issue. Cities then combined treatment, social work and effective policing in a response that treated “drug dependence as a health problem and drug use behavior as a public nuisance problem.”

Dorsey will need support from the progressive-majority board, which returned Tuesday from a monthlong recess. His eight other colleagues or their staff said they had either not seen the resolution yet or hadn’t had a chance to review it.

The mayor’s office said Breed looked forward to working with Dorsey to “build on the work we’ve done and find new resolutions that can help us move forward,” adding that the work in the tenderloin and citywide was challenging and “requires sustained focus. ”

His resolution, which he will introduce at Tuesday’s board meeting, calls on 21 city departments and six commissions to report within 90 days what they need to better coordinate responses and fix problems. It also calls for a look at what’s worked in other cities. The board will then need to agree on “evidence-based” solutions, which would require legislation and goals but the timeline for that isn’t yet clear.

The 21-page resolution already includes detailed recommendations for departments focused on public health, criminal justice, enhanced transparency and what Dorsey calls “Right to Recovery” and “Sober New Deal” programs.

Public health interventions include treatment on demand, which voters mandated years ago, but which continues to be elusive, frustrating advocates and officials.

It also includes supervised drug consumption sites, which Gov. Gavin Newsom recently shot down when he vetoed a bill to allow pilot programs in San Francisco and two other cities.

Dorsey said he’s a huge advocate for abstinence-based treatment, but he supports supervised consumption sites — and addressing resident concerns that sites won’t be magnets for drug activity — because “abstinence-based recovery only works when you’re alive.”

Tuesday’s press conference touched on a debate about whether San Francisco’s harm reduction policy — reducing risks for people who use drugs — is working. Some advocates and officials argue that the current approach is failing and the city should fund more programs to help people get sober, sometimes without offering medication. Members of a group that’s critical of harm reduction strategies, Mothers Against Drug Deaths, were present at Tuesday’s event.

National studies for decades have shown that abstinence techniques are less effective than medication-assisted treatment, with failure rates of at least 75% versus 40% to 60%.

Stefani said the city should continue investing in harm reduction such as needle exchange programs, but it needs more treatment options.

“We must accept that the disease of addiction is not a free license to use on the streets until you kill yourself or seriously harm someone else,” Stefani said. “We cannot continue to enable people to their deaths and create miserable conditions for others living in this city.”

The city’s head of behavioral health previously stressed that the health department was open to suggestions, although state law requires medication-assisted treatment to be offered at rehab facilities to get funding.

Sara Shortt, who sits on a city mental health committee, said it’s not fair to say that harm reduction has failed since it’s not properly funded.

“(Treatment) should be on-demand, low-barrier, affordable, easy to access and plentiful and we’d see a sea change in the number of folks who are recovering from substance use disorder and the number of overdose deaths,” she said.

Criminal justice strategies in the plan aim to target open-air drug markets through community-based interventions, such as offering alternative employment, but not necessarily through more arrests and incarceration. Dorsey proposed that people arrested for drug dealing would be released on geo-fenced ankle monitors and then subject to search and seizure instead of being rearrested.

It would also add more sober-living environments for people coming out of jail and fall-back options if they continue to use.

“Sober New Deal” programs include job training for people in recovery that could stabilize them and also address understaffing in drug counseling and treatment programs.

The resolution would also implement all recommendations from the city’s street-level drug dealing task force, including harsher consequences on repeat drug dealers without substance use problems and a 24/7 treatment center.

As a potential funding source, the resolution points to the city’s legal settlements in opioid lawsuits worth more than $100 million. The board can determine how to spend those dollars earmarked to fight the opioid crisis.

It wasn’t immediately clear how the supervisors’ plan would prove more effective than Breed’s Tenderloin emergency, especially when her officials cited similar studies about European successes when asked about their approach.

According to data and residents, the emergency led to more people in shelters and cleaner streets, but not a significant change in drug activity. Breed sent more officers to the neighborhood only after the emergency ended, citing staffing issues, but police significantly increased drug citations after a new district attorney entered office. Critics have accused Breed of reigniting the war on drugs.

The centerpiece of the emergency — a drop-in center in UN Plaza — had coaxed few people struggling with drug use into treatment after three months. The center will close at year’s end.

Dorsey said any plan to address drug overdoses should be citywide and sustained. It should also be backed by political consensus.

“The main lesson of the Tenderloin emergency is that the place where there is going to be political rancor, if there is going to be any, is the Board of Supervisors, so that’s where we should start,” he said.

Mallory Moench (she/her) is a San Francisco Chronicle staff writer. Email: Twitter:@mallorymoench


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