by Lupe Velez
The Board of Supervisors Public Safety and Neighborhood Services Committee sent Supervisor Matt Dorsey’s proposed “Recovery First” ordinance to the full board at its April 24 meeting. But not before the measure went through redefining the term “recovery” from substance use disorder and dozens of members from the Treatment on Demand (TOD) coalition sounded off during public comment.
For several months, several public health organizations and advocacy groups comprising Treatment on Demand fought the policy over its definition of recovery—an abstinence-only model—and its potentially dangerous impacts on drug users.
TOD advocated for changing the narrow definition of recovery from “abstinence from illicit drugs,” to the one shared by Substance Abuse and Mental Health Services Administration (SAMHSA), American Medical Association, and American Society of Addiction Medicine definition, and favored by harm reduction proponents. Recovery, as SAMHSA and others define it, is “a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.”
The treatment coalition’s efforts included hosting a panel with physician experts in addiction medicine and offering several policy amendments that would support the continuum of evidence-based approaches available to individuals who use drugs.
Dorsey’s policy proposal does not come as a surprise in light of the City’s and Mayor Daniel Lurie’s most recent actions addressing the overdose crisis, including “police friendly” triage centers, and increased drug raids. Responding to advocates’ fears, Dorsey claimed that his policy is “aspirational” and contains no real enforceable changes to drug policy. He also denied that it is a threat to harm reduction funding or evidence-based approaches to addressing substance use disorders. Despite his assurances, Dorsey posted a thread on X decrying UCSF Psychiatry’s position on the dangers of abstinence-only approaches to drug policy. To those outside drug-treatment circles, “Recovery First,” might resound as an aspirational slogan for addressing substance use disorders, but those familiar with “Housing First” recognize it as a veiled attack on any policy that prioritizes stable housing for those experiencing homelessness or substance use disorders without first requiring them to meet certain conditions.
Upon arrival at the committee hearing, the public was handed a news release announcing Dorsey’s amendments to the proposal, which was enough to win support from the San Francisco-Marin Medical Society. According to the release, the amendments “ would prioritize long term remission from Substance Use Disorder–free from illicit drug use, through process of recovery– as the City ‘s primary goal.”
Adding the new language came as a surprise, as Dorsey had resisted changes to his legislation after publicly denouncing opponents, such as the Drug Policy Alliance and UCSF Psychiatry, as enablers who promote drug use over abstinence.
During the hearing’s public comment period, TOD coalition members and organizations thanked Dorsey for significantly amending his ordinance. They also emphasized the importance of harm reduction and how there is no “one size fits all” method of recovery.
“Recovery is messy and non-linear. We want to open doors and not give people ultimatums,” said Lydia Bransten, executive director of the Gubbio Project. Supporters of the ordinance who were apparently unaware of the changes to the recovery definition, displayed signs reading “Drug Enablism Kills,” signs given to them by Dorsey’s team. All of this ran counter to Dorsey’s messaging in the hearing in support of harm reduction. Speakers from Positive Directions, a local drug rehabilitation outfit, approached the lectern with comments such as, “Harm reduction doesn’t work” and “Enough is enough.”
In advancing his proposal to the full board, which has enough sponsors to assure its passing, Dorsey could declare a political victory. However, the TOD coalition could say the real win was pressuring Dorsey to secure medical and scientific backing for his ordinance. Without any evidence-based methods, people undergoing substance use disorder might face a rockier path to recovery, said Jennifer Friedenbach, executive director of the Coalition on Homelessness, the advocacy organization that publishes Street Sheet.
“We are proud of the fact that we help people on the path to recovery every day, a path that can start at any number of places, and for some people that means harm reduction programs,” said Laura Thomas, senior director of HIV & harm reduction policy at the San Francisco AIDS Foundation. “I appreciate being in this room with so many people that are in support of recovery. That’s the one thing that we all agree on—we want the health and well being of those who use drugs.”
