Last year, 621 people died of drug overdoses in San Francisco. To put this in perspective, 173 people died from COVID-19, which is identified as the primary public health crisis in the Bay Area.
For years, San Francisco has tacitly encouraged drug abuse with remarkably lenient policies, and those policies are now inadvertently killing hundreds of people annually. San Francisco uses a policy approach called “harm reduction,” which stresses “culturally competent, non-judgmental treatment that demonstrates respect and dignity for the individual.”
But this approach, as it is practiced within San Francisco, is inhumane and cruel. It is destroying the dignity of the lives that some could have with more sensible policies. In addition to overdose deaths skyrocketing, drug abuse has increased in San Francisco, and it is becoming more difficult for addicts to affect positive change.
If you spend much time in San Francisco, you know this, as several areas of the city have become de facto open-air drug bazaars, with drug abuse and drug sales taking place for all to see. Harm-reduction policies are expanding drug use among youths through the dispensation to homeless adolescents of “safe snorting kits” and “safe smoking kits” for crack use. As if any crack use could be considered “safe.”
There are an estimated 25,000 drug users in San Francisco, which if anything is too low of a count since that estimate is nearly two years old. This exceeds San Francisco’s high school population by more than 50 percent and works out to about 522 drug users per city block. Sadly, thousands of human tragedies unfold every day, eviscerating those who use drugs, and forever affecting the lives of those who see it daily, including many children.
Drug abuse is challenging to treat, but a recent handbook of best practices for substance abuse treatment by the Department of Health and Human Services shows that targeted treatment can be very effective, particularly when intervention occurs early.
But a drawback to San Francisco’s acceptance and facilitation of drug use is that it prevents early intervention. Unless San Francisco completely changes how it views drug abuse, these numbers will become even worse. The country’s most progressive city needs to understand that their policies are creating implicit death sentences for many who could be helped with a different policy approach.
Understanding this begins with the simple economics about drug use, which highlights why harm reduction has failed. On the demand side, drug users come to San Francisco from elsewhere because they know the city tolerates and facilitates drug use, which includes providing free hypodermic needles. While giving away nearly 5 million clean needles annually (which boils down to nearly 6 needles for every San Franciscan) admirably reduces communicable diseases, it has created a public health hazard, because about two million used needles are disposed of on city sidewalks. Over $30 million has been spent on dealing with drug abuse within the public transit system, but one could hardly tell this by viewing transit stations that anything has been done to deal with this issue.
On the supply side, selling drugs in San Francisco has become extremely profitable, given a demand side of 25,000 consumers and the city’s tolerant policies. In contrast to most other cities, the drug trade in San Francisco operates within what is almost a normal marketplace setting, where buyers and sellers can find each other easily, and with a relatively small chance of being arrested. Both of these factors promote relatively low prices, which stimulate demand, and high profits, which stimulate supply.
By normalizing drug abuse, San Francisco has created a perfect storm of a vibrant, well-functioning market of buyers and sellers who trade drugs much like a basket of fruit is traded at a farmer’s market. Unfortunately, the basket that is being traded in San Francisco’s drug bazaar is increasingly becoming the opioid Fentanyl, which can be 100 times more powerful than morphine.
Fentanyl is sufficiently strong that much less than one milligram is used as general anesthesia during major surgery. Just two milligrams—the equivalent of about 25 grains of sand—can be lethal. Emergency personnel responding to a Fentanyl overdose must take precautions so that they do not accidentally inhale Fentanyl. And yet Fentanyl is now being widely traded every day in San Francisco, driving up overdose deaths to about two daily.
What to do? Drug addiction can be treated medically and compassionately without viewing it as part of normal, everyday life, which is what is being practiced today in San Francisco. The city currently allocates over $5 billion to community health and human welfare.
Surely those budgets can be repurposed to treat drug abuse using best practices as outlined by the Department of Health and Human Services in conjunction with greater efforts to identify family members who can assist with treatment and support. At the same time, the city must reduce the amount of Fentanyl and other lethal drugs that are being sold routinely in open-air markets.
Many of San Francisco’s drug users have lost control over their lives. The last thing that drug addicts need is another drug pusher, but this is what San Francisco’s policies have created. Lives can be saved, but not unless policies are changed.