San Francisco Has A New Drug Policy Goal: Long-Term Remission

San Francisco is shifting how the city governs — and now describes — its goals around substance use and overdoses.

The Board of Supervisors on Tuesday voted unanimously to approve a largely symbolic measure aimed at changing the city’s framing around the drug crisis.

The “Recovery First” ordinance, introduced by District 6 Supervisor Matt Dorsey, establishes the city’s overall goal for drug use and addiction programs to prioritize helping people reach “long-term remission.”

“This legislation accomplished what I hoped it would, to align our civic aspiration with what any of us would wish for a loved one struggling with drug addiction,” Dorsey said during Tuesday’s meeting.

The city defines remission as “overcoming the illness of substance use disorder to the point of living a self-directed and healthy life, free from illicit drug use.”

The version passed on Tuesday is different from Dorsey’s original version, which prioritized an “abstinence-first” approach and named “long-term recovery” as the city’s North Star for addiction-related services.

The change came after doctors pointed to the fact that many people who are trying to curb their drug use may still experience relapse or could be seeking different outcomes than complete abstinence.

Health experts, including members of the San Francisco Marin Medical Society, representing more than 3,500 physicians, recommended that the ordinance broaden the definition of recovery to show that harm reduction and recovery are not mutually exclusive concepts.

“The data shows that recovery is often a non-linear process of self-actualization where harm reduction efforts, abstinence, and treatment are not in opposition with one another or mutually exclusive,” reads a letter recommending the amendments from the medical society.

Other advocates for harm reduction, a philosophy that emphasizes meeting drug users where they are at by promoting safer use practices, also called on supervisors to amend the policy. Programs such as safe needle exchanges and Narcan distribution provide life-saving tools that should also remain a priority within the city’s approach, speakers said at a recent committee hearing for the proposal.

Dorsey said both recovery and harm reduction have a role to play. But in the yearslong battle to reduce overdose deaths and outdoor drug use, these two camps have become political lightning rods.

“Despite the brevity of its one-sentence operative provision, (the ordinance) became something of a flashpoint in our drug policy debate,” said Dorsey, who identifies as a former drug addict in recovery. “In the end, I think that debate was truly helpful.”

Supervisor Jackie Fielder was among those pushing for adjustments in the final version of the ordinance.

“I want to thank the social workers, the street outreach workers and medical professionals who advocated for a more expansive and inclusive definition of recovery and a substance use disorder policy that affirms the dignity and potential of every single person struggling with addiction,” Fielder said.

Fielder, who represents District 9, will lead a hearing next week on a proposal for San Francisco to incorporate a model used in Zurich, Switzerland, where outdoor drug use and overdoses were similarly a major problem. The model calls for strong coordination and support for addressing all stages of drug-related issues, including prevention, treatment, harm reduction and law enforcement.

Dorsey has also expressed support for the approach, known as the Four Pillars.

Meanwhile, Mayor Daniel Lurie has already taken steps to scale back the city’s harm reduction efforts, as some voters have grown frustrated over a lack of progress on the drug crisis. His recent directive required health providers to only distribute safer use supplies, such as clean needles, to drug users who agree to participate in some form of counseling or treatment.

Lurie has also ended all outdoor distribution of safer smoking supplies like pipes and foil, which some studies have shown can help drug users move away from more risky forms of consumption like injecting drugs. He has also ordered increased police crackdowns on drug users and dealers.

Many health providers are still waiting for answers on where funding for the newly required counseling services will come from. Earlier this month, the city has opened up a new emergency mental health clinic at 822 Geary for individuals experiencing panic attacks, suicidal ideation or other psychiatric emergencies.

The stabilization center at 822 Geary currently has the capacity for four clients, but officials there said they eventually plan to scale that up to 16, so people can walk in or first responders can drop off people they encounter struggling on the street.

Just over 190 people died of overdose in San Francisco from January to March of this year, according to the most recent city data available. Fielder pointed out that at the current pace, the city is on track to reach its second-highest year for overdose deaths.

“Factions of the city want to present a false choice between harm reduction and treatment when both are sorely needed at this moment,” Fielder said. “The moment demands all of us to come together to achieve a steep and lasting decline in overdose deaths and the long-term remission of substance use disorders in San Francisco.”