For more than two decades, “harm reduction” was official policy in San Francisco. As a formerly homeless heroin and fentanyl addict in recovery, I saw firsthand how this policy, which tried to make illegal drug use “safer,” devastated the city. In my six months on the street in 2018, I watched harm-reduction groups hand out free drug paraphernalia; in the years since, I’ve seen harm-reduction workers distribute crack and meth pipes—without telling users how to get treatment.
Newly elected mayor Daniel Lurie has decided to move the city away from this failed model. Now, San Francisco has a chance to do the right thing: expand access to treatment.
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Previously, San Francisco’s public health department required addiction-services providers to “develop harm reduction guidelines” and plan to “provide harm reduction treatment options.” The city even ran an ad campaign encouraging drug users to “[d]o it with friends,” and suggesting that addicts “[u]se with people and take turns.”
The results were disastrous. By 2021, San Francisco had more than 8,000 homeless people and recorded 720 overdose deaths. By 2024, some 1,000 drug dealers roamed the streets, and officials had seized 132 kilos of fentanyl in a 12-month period.
The chaos prompted city voters to elect Lurie last November. An heir to the Levi Strauss fortune, he campaigned on pragmatic approaches to the homelessness and drug crises. He promised within the first six months of his administration to stand up 1,500 shelter beds. And in his first day in office, he signed a “Fentanyl State of Emergency Ordinance,” which the newly moderate Board of Supervisors passed by a ten-to-one margin in February.
Earlier this month, Lurie introduced an executive directive to reform San Francisco’s homelessness policies. The most significant provision ends the city’s distribution of pipes, aluminum foil, and straws, used to smoke fentanyl and methamphetamine. The directive also consolidated overlapping street-outreach initiatives and merged the programs that give homeless people bus and plane tickets to return to friends or family outside of San Francisco. And the plan will fund the city’s sober living pilot project, a two-year transitional housing program that requires residents to abstain from drugs and alcohol.
Lurie’s turn away from harm reduction is welcome news. That approach not only enabled illegal drug use but also diverted resources from effective treatment. For example, the California State Department of Public Health granted one San Francisco nonprofit $12 million, some of which funded “syringe access sites”—in other words, the distribution of drug paraphernalia. That money would have been better spent expanding the city’s drug-detox system, which currently offers only 58 beds for an estimated 25,000 users.
Lurie has also brought in new leadership. The previous director of Public Health, Grant Colfax, stepped down and has been replaced by the more pragmatic Daniel Tsai. Lurie pledged that, under Tsai, recovery from addiction would become central to the city’s behavioral health strategy.
Now that San Francisco has backed away from its full commitment to harm reduction, Lurie and other leaders must pursue real solutions to the drug crisis. These include establishing stabilization centers for the sick and addicted; shelters that offer referrals to treatment; and transitional, drug-free housing with mandatory programming, job training, and recovery services. These approaches, which prioritize recovery over harm mitigation, are what’s needed to break the cycle playing out on our streets.
A growing coalition of people in recovery stands with the mayor in support of these new policies. Why? Because we’ve fought our own demons—and survived homelessness, jail, prison, and addiction. We know what it takes to recover. Now, we’re fighting to save San Francisco.
Photo by Tayfun Coskun/Anadolu via Getty Images
