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.

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?”