Newsom's Plan to Crack Down on Fentanyl in San Francisco Could Cause More Harm Than Good, Some Addiction Experts Say

Gov. Gavin Newsom and Mayor London Breed are doubling down on law enforcement to get a grip on drug-related challenges in San Francisco’s city core.

Addiction experts, however, say that the city and state’s latest effort repeats tough-on-crime tactics and rhetoric that have not succeeded in curbing drug dealing in the long run, and at times have led to spikes in overdose deaths when the intervention ends.

“Unfortunately, these crackdowns on the drug supply don’t work as well as we want them to,” said Daniel Ciccarone, professor in addiction medicine at UCSF. “When we say we want to crack down on the supply and get more people into treatment, if you don’t do that carefully, the only thing you do is add to stigma and barriers to treatment. That is what the evidence shows.”

Increased police presence could initially deter drug use and dealing. Officials did not state how long the operation would last, however, and that could also lead to other unintended consequences, said Vitka Eisen, CEO of the nonprofit HealthRight 360.

“When you increase enforcement on the street and pressure the supply side, what often results is much more chaotic drug use patterns in which people are more desperate to get drugs, prices go up, they use in a less safe way,” Eisen said. “So one of the unintended consequences of increased enforcement is increased overdoses.”

Starting May 1, Newsom is sending additional California Highway Patrol officers into the Tenderloin and South of Market neighborhoods, where the majority of overdose deaths have occurred in recent years.  There are currently 75 CHP officers assigned to the area, and that could go up to 84, according to CHP officials. Fourteen members of the California National Guard will also work to train San Francisco police in identifying and responding to potential trafficking cases.

Newsom and Breed stated that their focus in San Francisco is around drug dealers and traffickers, not drug users themselves. But there is often overlap in those populations, according to addiction researchers.

“There is a false dichotomy here in terms of people who are drug merchants and people who are using drugs. You know, it can often be the same people. The people who use drugs might actually be selling or trading drugs as well,” said Alex Kral, an epidemiologist at the independent nonprofit research institute RTI International. “If you’re simply doing an intervention to try to remove people who sell drugs, you’re actually also hurting people who use drugs.”

Both experts point to how, earlier this year, overdose rates in San Francisco rapidly increased shortly following the closure of the Tenderloin Center, a drop-in social services center and safe consumption site that operated for 11 months. Trained staff at the facility reversed 333 overdoses in 11 months before the facility closed, according to city data.

The Tenderloin Center opened in January 2022 as part of a wider intervention for the neighborhood that aimed to curb outdoor drug dealing and use, clean city sidewalks, get more people into drug treatment and reduce overdose deaths. The temporary emergency operation lasted 90 days and the center stayed open for 11 months.

“Without a replacement (for the Tenderloin Center), and then to instead focus on policing people, it’s no surprise to me that there are more overdoses this year than last year,” Kral said. “There’s no surprise to me that things will get worse with this approach.”

Residents say help is needed

Newsom’s intervention comes alongside serious concerns about safety in the Tenderloin and in SoMa and complaints about street conditions that some feel are out of control. Residents who spoke to KQED said they are desperate for solutions.

Jacob Thornton, 32, lives at Trinity Place in SoMa and said he has been held up at knifepoint twice outside his building. He supports the additional law enforcement resources coming into the neighborhood.

“The police recommendation to me when I got a knife pulled on me was to not walk outside and not be on the sidewalk. I mean, wow,” said Thornton outside his building on May 1, the day the latest operation was set to begin. “I have not seen any National Guard yet, but I’m very excited for them to come if they are coming, because this block in particular is just absolutely wild and no one seems to do anything about it.”

Haley Hampton splits her time between her home in the city of Richmond, where her kids and grandmother live, and a room on Jones Street in the Tenderloin to be closer to her son, who was recently released from prison.

She too welcomed the additional attention to the neighborhood, but was skeptical that it would lead to lasting change.

“I’m out here every night making sure that no one is in the corner overdosing or drowning from their alcohol,” she said. Sending in CHP “can make a difference only if they include the community that it wants to change. People have their vices, but we don’t give them a chance.”

Hampton regularly shows friends and neighbors in the area how to administer Narcan, a naloxone nasal spray that can reverse an opioid overdose, and said that the community has learned to look out for itself.

“One needs to take only a 20-minute stroll in the Tenderloin to know there’s something amiss. And I understand the political and administrative and even civic call for law and order,” said Ciccarone. “But the drug supply is unbelievably resilient in America. You try to curtail it like a snake and you cut off its head, but it just grows two heads.”

How other places are responding to fentanyl

Places outside California are now trying strategies to reduce the demand for illicit drugs. Canada, which is also grappling with fentanyl, opened ATM-like machines that can dispense safe amounts of opioids in controlled settings, for example.

The machines helped reduce overdose deaths and drug dealing by regulating what is in the supply, and by limiting the demand for users to buy drugs illegally. The Canadian government in 2021 expanded the service program to four cities.

More than 200 safe consumption sites also operate globally in more than a dozen countries, including France, Denmark, Canada, Australia, Switzerland and others. The facilities offer a space where people can use drugs and trained staff can reverse an overdose if it occurs, while also connecting people with other health and social services.

New York City has found early success with reversing overdoses and reducing public drug use by operating two safe consumption sites at a private nonprofit called OnPoint NYC.

In 2020, Rhode Island became the first state to legalize supervised drug consumption services, and now has a state-approved plan to open a site in Providence in early 2024. The state has allocated $2.6 million from opioid settlement funds to pay for the first year of operation.

In San Francisco, Breed has said she supports opening safe consumption sites and has support from the Board of Supervisors. But last year, Gov. Gavin Newsom vetoed legislation that would have allowed sites to operate on a pilot basis in San Francisco, Los Angeles and Oakland.

San Francisco plans to move forward with opening a safe consumption site nonetheless, using a model borrowed from New York City, where a nonprofit pays for and operates the overdose prevention services.

But those efforts have hit delays because the nonprofits that want to provide safe consumption say they can’t afford to do so without help from the city. San Francisco has a projected $130 million in funding coming in through settlements with pharmacies, drug manufacturers and distributors for their role in the overdose crisis, and the money is earmarked specifically for overdose prevention, such as purchasing and distributing Narcan.

City Attorney David Chiu has not yet agreed to use the funds for supervised consumption sites.

“Not only is the U.S. not up to international standards on overdose prevention, but San Francisco and California as a whole are not up to national standards,” Ciccarone said, referring to the steps that some states are taking to address fentanyl overdoses and street-level problems related to drugs.

In the meantime, San Francisco has been piloting a drug testing program, but on a small scale. The idea is to offer people a chance to test what is in their supply and open conversations about safer use and even treatment. The city has also ramped up distribution of Narcan.

“What we need here is leadership, not complaining and pointing fingers and draconian responses. We need courage, which combines both the heart-centered approach and bold stances that are not same old, same old,” he said. “That doesn’t work in the fentanyl epidemic.”

A rock and a hard place

The California Legislature is currently debating nearly 30 bills introduced this year that aim to combat the fentanyl crisis as overdose deaths statewide have also ticked up. Some of the bills seek to ramp up prison sentences for fentanyl dealers, while others focus on education and prevention.

Supervisor Matt Dorsey, who represents the SoMa neighborhood, has repeatedly called for increased police presence to deter drug use and dealing.

“San Francisco is on the precipice of a potentially catastrophic police staffing shortage, and there are too many public safety problems we’ll be helpless to solve if we don’t start solving SFPD’s understaffing crisis first,” Dorsey stated earlier this year when advocating for police recruitment bonuses (PDF).

San Francisco Public Defender Mano Raju said he fears that would lead to negative outcomes similar to the crack cocaine and heroin epidemics.

“We know from 50 years of the war on drugs that the people who are likely to be targeted by any forthcoming operations will be in low-income and Black and Brown communities, including those who have been trafficked or coerced into the drug trade under threat to themselves and their families,” Raju said in a press release after the new plan was announced.

Providing housing and places where people can leave the street for safer settings to use drugs can be closer to the win-win politicians are looking for, Kral said.

There’s an economic incentive, too, Kral added. His research on local public health and public safety spending estimates that the city could save a minimum of $2.6 million if it were to offer places where people could use drugs more safely and out of the public.

“Do you want to spend your money on jails,” he said, “or do you want to spend your money on these sites that can actually help people?”