In response to a growing crisis of drug overdose fatalities and public drug use, San Francisco is on the brink of implementing a “recovery first” policy aimed at prioritizing abstinence from illicit substances. This controversial policy has stirred significant debate within the city, known for its pioneering harm reduction strategies.
The proposal, championed by Supervisor Matt Dorsey, who is himself in recovery from alcohol and drug addiction, emphasizes ceasing drug use as the main objective. Critics argue that this focus could alienate individuals who are not prepared to stop using drugs, while supporters assert that the city’s current permissiveness in drug use prevention has failed to combat addiction effectively. Dorsey has refined the policy in his public safety committee to ensure that providing safer-use supplies and connecting individuals to social services remain vital components of San Francisco’s drug strategy.
The contentious nature of this initiative was apparent during a public hearing, with participants vocally expressing their support or opposition. Advocates of the harm reduction approach argue that it saves lives by offering support without mandating abstinence, noting that traditional abstinence-focused methods can prove fatal for those unable or unwilling to comply. Conversely, individuals like Brendan Harris, who has maintained sobriety for six years, emphasize the importance of guiding people towards treatment to break the cycle of addiction sustainably.
San Francisco’s public health department has previously advised drug users to avoid using substances alone to mitigate overdose risks; however, this has been criticized for potentially encouraging unsafe drug use. Mayor Daniel Lurie, who assumed office this January, has committed to resolving the city’s fentanyl crisis, which claimed over 600 lives last year due to accidental overdoses. He has directed city-supported nonprofits to prioritize treatment or counseling before distributing paraphernalia like foil and pipes, restricting the distribution of such items in public spaces like parks and sidewalks.
The revised proposal underscores that achieving “long-term remission of substance use disorders” facilitated by comprehensive evidence-based recovery services should be the city’s primary aim. It describes recovery as the journey towards making positive, healthy lifestyle changes for those with substance use disorders. Dorsey defends the notion of aspiring to a drug-free lifestyle, suggesting that abstention might also involve medically-assisted treatments like methadone. Though San Francisco offers various support services for those battling addiction, public perception often focuses on the visible distribution of paraphernalia, overshadowing other efforts.
Dorsey believes this new policy redefines harm reduction, aiming to incorporate it as a part of broader recovery efforts. The proposal’s amendments were presented with contributions from the San Francisco Marin Medical Society, representing a significant number of physicians. The full Board of Supervisors is slated to vote on the proposal next month, and the approval is anticipated, with seven out of eleven members either sponsoring or co-sponsoring the initiative.