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Tenderloin SF

Does San Francisco Enable Drug Use?

TogetherSF's Panel Explores the Problem

••••••• May 2023 •••••••

That question anchored TogetherSF Action’s 4/5/23 community meeting hosted by “policy experts, former City Hallers and community organizers." Their space on Mariposa Street was packed - 200 attendees. The Westside Observer previously covered TogetherSF’s background and vision of government accountability via public empowerment.

Executive Director Kanishka Cheng’s carefully researched theme was; “City Departments Must Coordinate to Meet Demand for Recovery Programs." Alongside this call to action came the message that “power structures do not change without public pressure." City Hall won’t move - until residents demand a response proportionate to the drug carnage and chaos that occupy City streets.

The Crisis

Fentanyl overdoses have killed more San Franciscans than COVID. Fentanyl is now cheaper than heroin. The difference between wholesale and retail prices for fentanyl makes street sales immensely profitable. Yet, SF fails to prosecute dealers; no convictions for fentanyl sales in 2021. Most dealers are granted diversion via the Community Justice Center, even when caught with up to 100 grams of fentanyl, per Ms. Cheng. Some dealers sent to restorative justice programs are non-compliant. Undocumented immigrant dealers aren’t prosecuted - to avert deportation.

Open-air drug markets are becoming normalized. So are overdoses, despite the City’s considerable efforts to reverse them. Ms. Cheng noted that the City’s Street Overdose Response Team follows up in less than 40% of overdose cases. Of these successful follow-ups, just 4% are referred to residential treatment. But, 60% are taught how to use drugs more safely. Therefore, “Street response teams aren’t getting drug users into treatment.”

Decriminalization hasn’t reduced overdose risks either. For instance, City policy requires a referral to Drug Court after five citations for public drug use. But, from September through December 2022, nobody reached that towering threshold. Moreover, “drug citations are markedly low ." "San Francisco allows open drug use," Cheng lamented. So drug users keep using. Fortunately, DA Brooke Jenkins plans to lower the drug citation threshold to three.


Street Overdose Response Team follows up in less than 40% of overdose cases. Of these successful follow-ups, just 4% are referred to residential treatment. But, 60% are taught how to use drugs more safely.”

Cheng stressed that understaffing hobbles the DA’s drug crimes prosecutions. However, DA Brooke Jenkins recently sought funding for three more prosecutors and announced a doubling of felony narcotics charges against drug dealers. And, the police are stepping up drug seizures and arrests. A 500-officer shortage constrains these efforts.

Harm Reduction is Inadequate

The City’s “Harm Reduction” approach to drug addiction “doesn’t focus on recovery." Moreover, a false dichotomy has been created between Harm Reduction and Abstinence models. TogetherSF Action views them as 2 points on a spectrum of drug treatment services. But abstinence programs, limited to 86 beds, are only available after release from jail.

Harm Reduction insists upon individual liberties despite a massive death toll. It’s analogous to promoting gun rights despite rising firearm casualties, per Ms. Cheng. In any case, the Harm Reduction model has been overwhelmed by the fentanyl crisis. “By focusing on not punishing drug users, the City has lost sight of the fact that behavior change is necessary." For those who can’t quit on their own, compelled treatment should be considered.“Our streets aren’t a road to recovery”, Cheng insisted.

DPH Gets it Wrong

The Department of Public Health’s (DPH) drive to ensure that addicts are supported rather than stigmatized has de-prioritized recovery services – a fatal flaw. Cheng characterized drug addiction as “a progressive disease that ends in death." Current City services are palliative - aiding that sad transition. As a result, City streets are “like Hospice centers” for addicts.

The DPH “has been more aggressive in combating smoking than open drug use," Cheng mused. The DPH Behavioral Health Services budget was $607 million in FY 2021-22. But only 12% of that amount went for drug treatment services. Despite a huge demand for drug treatment services, key programs operate below capacity. Some 16 contractors are paid for a hodge-podge of drug services with little requirement to show results. TogetherSF Action wants these contracts to be streamlined and outcome-based.

While the City does a good job with drug withdrawal services and outpatient opioid replacement programs, post-detox support and wrap-around care is deficient. For example, the City has a policy to place 70% of individuals seeking residential drug treatment programs within 10 days. But, only 54% of candidates get placed within that time frame. In the throes of addiction, waiting 10 days is harder than scoring another hazardous fix.

Intriguingly, Dr. Jeffrey Hom, from the DPH Behavioral Health Services, claims that the median wait time for residential drug treatment is four days. He said that during the 4/10/23 “Virtual Town Hall on Mental Health and Addiction” organized by Senator Scott Wiener. The Westside Observer asked Ms. Cheng about these differing wait times. Her response was, "…that '4-day period' is four days after the person has already been assessed by the City for the level of care they need – which is a process that has about 6 days attached to it. So the 4-day figure is a partial truth." Ms. Cheng provided a DPH Behavioral Health Services report from 2021-22 documenting that; “Overall, 54% of clients were admitted to residential treatment within 10 days of request." The report acknowledged that DPH failed to meet its stated goal.

Another failing is that intake clinics are only open weekdays, from 8 to 5. Meanwhile, decisions to stop drug use arise 24/7. As for the now-closed $22 million Tenderloin Linkage Center, it “did not work," Cheng contended. Although 333 overdoses were reportedly reversed, less than 1% of the clients were linked to mental health and drug treatment programs. And drug dealing flourished outside.

New Models Needed

Cheng cited a Los Angeles Salvation Army report that found a 6-month drug treatment program yielded a 10% sobriety rate. However, a 2-3 year residential program that included life-skills training and workforce development brought a 90% success rate. Recovery takes time and resources.

Another model is San Antonio’s $100 million Haven for Hope, which provides full-spectrum drug treatment services. It serves 1,700 clients annually at the cost of $16,000 per client. One outcome was an 80% reduction in unsheltered homelessness. Several counties could support a similar Bay Area regional campus.

Ms. Cheng also touted the success of Portugal’s approach. It prohibits open drug use or dealing but provides full treatment on demand – including an array of abstinence-based programs. For addicts too sick to help themselves, Portugal compels treatment in a humane manner. Now, Portugal’s drug death rates are among the lowest in Europe.

TogetherSF Action wants the City to alter its mind-set, ramp up recovery services and compel life-saving treatment as Portugal has successfully done. “We should meet people where they are – not keep them where they are.”

Expert Panel

 The evening ended with a Q&A featuring four panelists who overcame their addictions; Supervisor Matt Dorsey, who introduced the “San Francisco Recovers” Resolution and “Right to Recovery” legislation to enforce drug-free zones around drug treatment facilities, Tom Wolf, founder of the Recovery Education Coalition, Gary McCoy, HealthRIGHT 360’s VP for Policy and Public Affairs and Cregg Johnson, co-founder of the Positive Directions Equals Change program. They generally shared the perspective set forth by TogetherSF Action. Cregg Johnson added; “bust all dealers and they won’t come here."

The Plan

TogetherSF Action wants to; “End open drug use and get users into recovery." Accordingly, the City needs to;

  1. Arrest and prosecute drug dealers
  2. Work with federal and state agencies to prevent cartels from bringing drugs into the City
  3. Fully staff the SFPD
  4. Add funding for 24/7 intake centers
  5. Make residential treatment available on day 1
  6. Fund more residential treatment and step-down beds
  7. Add abstinence-based recovery options to the continuum of care.

People Power

What was remarkable about this meeting was the passion and energy in the room. That came from a contingent of folks allied with the speakers and their non-profits. Their fervor could ignite a fed-up public to launch a movement. Supervisor Dorsey - and his lonely quest to withdraw sanctuary protections from undocumented immigrant fentanyl dealers - clearly got a boost from the animated crowd.

There's a potential conflict of interest when non-profits lobby for City resources that advance their work - and growth. Susan Dyer Reynolds has exposed some self-serving and suspect behaviors in the non-profit realm. So has the Controller’s Office. But soaring fentanyl fatalities and spreading street squalor require all hands on deck. Old approaches aren’t working. City Hall isn’t keeping up. Into this void flows People Power with fresh ideas and urgent solutions. These too, need watching.

Hat Tip: Thanks to Kanishka Chen and staff for sharing meeting transcripts.

Dr. Derek Kerr is a San Francisco investigative reporter for the Westside Observer and a member of SPJ-NorCal. Contact:

May 2023

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