San Francisco’s Deathly Compassion

San Francisco has a serious drug problem, particularly among its homeless population. Roughly 8,000 people live on the city’s sidewalks or in its alleyways, public parks, and playgrounds. People with needles in their arms and legs, holding glass pipes and lighters, are a regular sight. Users go limp in doorways and tents, or they career about, dazed and distraught, or angry and violent. Dealers selling heroin, Fentanyl, methamphetamine, and crack are ubiquitous.

So, too, are the advocates for “harm reduction,” which holds that widespread drug use should be accepted but its worst effects mitigated. Organizations such as the San Francisco AIDS Foundation, the Harm Reduction Coalition, the Drug Users Union, and even the Department of Public Health, in partnership with The DOPE Project, focus almost exclusively on “safe drug use.” In fact, the Drug Users Union’s goal is “to create a safe environment where people can use & enjoy drugs as well as receive services.” This attitude led to today’s humanitarian crisis: thousands of people living on San Francisco’s streets, languishing in an endless cycle of homelessness and addiction.

Every day of the week, nonprofits and churches such as Glide Memorial partner with the city to distribute drug use supplies to addicts at designated pick-up points. With an empty backpack, I visited three such spots recently in a single afternoon.

Through open doorways, friendly workers asked what I needed. They suggested items and eagerly gave me what asked for—needles (what size?), naloxone (do you know how to use it? Here, let me show you!), rubber tourniquets to pop my veins, little metal cookers for my dope, sharps containers, sheets of foil and straws for Fentanyl, and mounds of alcohol pads, gauze, and bandages. My backpack was soon bursting; I collected 170 needles.

Not one person asked if I was interested in treatment. No one discussed detox or gave me a flyer with listings for local 12-step meetings. No one inquired about my physical or psychological wellbeing. I could have anything I wanted—except for help getting off drugs.

The idea of harm reduction seems noble. Access to clean needles reduces diseases like hepatitis and HIV, and naloxone can bring overdosing people back from the brink of death. Carefully monitored methadone-maintenance programs can return individuals struggling with opiates to a more stable life.

Harm reduction has mutated from ameliorating the collateral negative effects of addiction to promoting drug use as a positive lifestyle choice. Yet the lives of San Francisco’s addicts clearly aren’t improving. They’re sicker, more numerous than ever, and dying in staggering numbers. The body count is rising from Fentanyl, the highly potent synthetic opioid that has become the substance of choice. Last year’s 441 overdose deaths represented a 70 percent increase, and 2020 will likely be another record-breaking year.

Still, true believers carry on, convinced that they’re doing right by helping addicts do more drugs. It’s an unconscionable position. All people deserve a chance to live free of the substances preventing them from a healthy, self-sufficient life. They need someone to say, “I believe in you; let me help you escape addiction,” not, “You’re a drug user, let me help you remain an addict.”

Question the self-described experts, though, and you’re dismissed as a rube, even as their grand experiment—the giant petri dish of San Francisco—is evidence that they’ve failed.

And it’s getting worse. Homeless addicts given hotel rooms during Covid-19 are offered the complete range of drug paraphernalia. Boxes of needles, glass pipes for meth and crack, and Fentanyl supplies are laid out in the lobbies like a breakfast buffet. Fatal overdoses, not surprisingly, have spiked. All the hotels should have been drug-free zones, yet not even one was designated for sober people or for those trying to kick their habits.

The effects of enabling addiction are far-ranging. Low-income neighborhoods, where the majority of homeless drug users concentrate, are disproportionately affected. Poor immigrants, children, and seniors watch as addicts use drugs in front of them, stealing to support their addiction and behaving in other horrible ways. Small businesses can’t operate in such environments and are forced to close.

Condoning illegal drug use means accepting everything that accompanies the business: human trafficking, sexual exploitation, political corruption, and environmental disaster. Recognizing these connections is essential. It’s why we condemned the ivory trade and child labor. Why do we now give a nod to illegal drugs that perpetuate some of the worst crimes known to man?

We can change course and focus on recovery. Options exist. The Salvation Army Harbor Light Center gives homeless individuals and families a place to stay while they pursue sobriety; the San Francisco Adult Probation Department’s reentry division gives newly released prisoners up to a year in residential drug-treatment programs. It’s time to invest in organizations like Community First Village in Austin, Texas, which recognizes that possession of controlled substances is illegal and provides permanent housing to the chronically homeless—with a work requirement. Residents are expected to abide by the law and take advantage of on-site rehabilitation and counseling. Such organizations give more to those they help by expecting more of them.

Drug addicts need a lifeline, not a millstone. For those who doubt that it’s time to push back against harm-reduction advocates who do little more than throw fresh needles, fentanyl foil, and meth pipes at the sick and dying, I have a suggestion: come to San Francisco and have a look around.

Erica Sandberg is a widely published consumer-finance reporter based in San Francisco and the author of Expecting Money: The Essential Financial Plan for New and Growing Families. As a community advocate, she focuses on homelessness and crime and safety issues.