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Breed Proposes Mandatory Drug Screening, Treatment to Receive Cash Assistance From City

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Mayor London Breed speaks outside at a lectern, next to a bearded white man
San Francisco Mayor London Breed and San Francisco Board of Supervisors President Aaron Peskin speak with a crowd gathered for a Q&A about the fentanyl drug crisis in San Francisco at UN Plaza on May 23, 2023. (Beth LaBerge/KQED)

San Francisco Mayor London Breed wants to require residents with substance-use disorders to enroll in treatment programs before being able to receive welfare funds from the city.

“We are here because we need to make a significant change,” Breed said at a press conference Tuesday morning. “No more ‘anything goes’ without accountability. No more handouts without accountability. In order to get resources from our city, you will need to be in a substance-use disorder program.”

The mayor’s announcement comes amid a notable uptick in overdose deaths in San Francisco this year — with 563 reported through August — putting the city on track to have its deadliest overdose year on record, according to data from the city’s Office of the Chief Medical Examiner.

Breed’s proposal focuses on San Francisco’s County Adult Assistance Programs, which provides monthly payments of $697 to lower-income residents with housing, and about $105 to those who are unhoused. Roughly 5,200 residents are currently enrolled in the program.

If approved, the mayor’s plan would require all adult recipients, 18 to 65, identified as having substance-abuse disorder to participate in some form of treatment in order to continue receiving their monthly payments from the city. The new rule would not apply to recipients who are supporting their children.

“We are proposing to require everyone who is receiving cash assistance through this program to first go through a screening to determine if they have a substance-use disorder,” Trent Roar, director of San Francisco’s Human Services Agency, which oversees the welfare program, said at Tuesday’s press conference. “Those who choose not to get assistance will no longer receive cash assistance.”

The proposal will have to first pass the full Board of Supervisors, where it’s sure to face some opposition.

A handful of the city’s more moderate supervisors, including Matt Dorsey, Catherine Stefani and Rafael Mandelman, have already endorsed Breed’s proposal.

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“I strongly support Mayor Breed’s initiative, which will better incentivize treatment and recovery for a population that’s at wildly disproportionate risk for drug addiction and overdose fatalities,” said Dorsey, who spoke at Breed’s press conference, noting that he, too, is recovering from drug addiction. “We’re facing an unprecedented loss of life in San Francisco, and we know coercive interventions can work.”

But Supervisor Aaron Peskin, the president of the board, and among its more progressive members, was quick to criticize the mayor’s approach, calling it politically motivated and wholly unrealistic.

“Mayor Breed does not have the ability, nor the will, to organize our many public safety resources to close down drug supermarkets and open-air fencing of stolen goods,” Peskin said. So “how does she think she will find the resources to drug-test thousands of welfare recipients? The answer is she can’t, and she won’t, and this would simply be silly politics if the issues we face as a city were not so serious.”

Soon after Breed’s announcement, Supervisor Dean Preston, another progressive member of the board, took to the social media to lambast the proposal.

It “singles out already-vulnerable people and makes it even harder for them to get the support they need to survive,” he wrote on the social media site X, formerly known as Twitter. “I am appalled to see this type of proposal — usually pushed by Republicans in states like Florida or Texas — in San Francisco.”


Several harm-reduction advocates also decried Breed’s plan, noting it flies in the face of public health research showing that coercive approaches to drug treatment can often backfire and acerbate the problem — and, in many instances, end up proving more expensive (PDF) to implement.

Some critics of Breed’s plan also questioned how people in the program would be fairly assessed, since a drug test alone cannot determine if someone has a substance-use disorder.

“Withholding the little amount people get on general assistance because of drug use is inhumane and paternalistic. It’s costly, and we don’t have enough treatment capacity,” said Vitka Eisen, CEO of HealthRIGHT360, a public health nonprofit that contracts with the city to provide services. “We have tried coercive policies again and again and yet here we are. All that coercion did not stop the substance-use disorders, it only resulted in more harm to people.”

Breed’s proposal is reminiscent of the Care Not Cash initiative that Gavin Newsom spearheaded while serving as a city supervisor in 2002. That plan, which was passed by voters and went into effect in 2004, after Newsom became mayor, slashed welfare cash payments from the city, diverting most of it to subsidize housing and food costs.

But the lack of affordable housing options created major roadblocks, prompting the city to purchase numerous single-room occupancy (SRO) hotels in the Tenderloin and South of Market neighborhoods. Conditions in those buildings, however, quickly deteriorated, repelling many would-be residents who continued to cycle in and out of emergency shelters, a 2022 San Francisco Chronicle investigation found.

Now, two decades later, the city continues to grapple with an epidemic of homelessness and an alarming increase in drug overdose deaths.

“Care Not Cash limited people’s ability to have any money to live on,” Eisen said. “I think it’s resulted in more misery.”

Breed on Tuesday acknowledged the controversial nature of her proposal, and said she’s prepared for “a fight” to convince the board to approve it.

“Everyone will have an excuse for why we shouldn’t do this. We will do everything we can to move forward and get people into treatment, controversial or not,” Breed said. “I’m tired of people telling me ‘No’ and saying what we can’t do. This is something, and this is better than nothing at all.”


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