Fighting Drugs with Drugs: A Way Forward for San Francisco

By Detroit Richards

San Francisco, once famous for the Summer of Love, beautiful views from the hills, and stunning architecture, is now known for having a large amount of human excrement on the streets, unchecked open drug use, and fearsome rates of overdose deaths and criminal activity. Fingers are unfairly pointed at the homeless population, who are scapegoated as the cause of all of society’s problems, and as a result the animosity towards those who are unhoused in the city continues to escalate. It is a sorry state of affairs for this beautiful city. 

It seems strange to me that the victims of the system—homeless people—are blamed for their own predicament, while city leaders who foster this attitude of us vs. them continue with minimal censure. The price of housing in San Francisco is out of control. The very minimum rent for a one bed apartment is around $2,000 a month, and the City lets these relatively affordable neighborhoods go to ruin. The Tenderloin, Lower Nob Hill, Civic Center, Mission and SoMa are communities under siege. Something has to be done to bridge the great divide and foster more harmony and peace. Currently we appear to be trapped in a war of attrition in which everybody suffers, leading to the decay of San Francisco, as well as to a massive exodus. 

The problem remains that the City is not providing any long term solutions to address the mental health, homelessness, and addiction crisis that is causing so many to flee San Francisco. Our leaders keep trying the same things that have failed over and over again, and then wonder why the problem is not being solved. The definition of insanity is doing the same things over and over and expecting different results. The War on Drugs was lost decades ago, yet San Francisco’s leaders are still fighting it. 

My blueprint for how to clean up our streets, make life more comfortable and safer for both housed and unhoused residents of San Francisco, and get dealers off our corners is unlikely to ever be implemented, but I truly believe the problem could be solved if the City had an appetite for compassion instead of punishment. San Francisco’s leaders need to look at the solutions embraced by Switzerland, Canada and Portugal if they want to truly find a way to restore the City to its former glory. 

The most important step would be to reopen the Shelter-In-Place (SIP) hotels and extend the safe parking provision for those who prefer that option. Having areas in which camping in a vehicle is safe and possible, with sewage, water, showers and security, would solve a lot of issues for both those living in their vehicles and those who live in the city. The SIP hotel system was a resounding success, and to reinstate it would benefit the entire city. 

For shelters to work they must be made a more attractive option for those who are homeless. There should be a shelter bed for every single unhoused person, and these beds need to offer privacy and no barriers to access. It should not matter if a service user is addicted, drunk, undocumented, mentally unwell, or exhibits behavioral issues. They should still be able to access a shelter space. 

If there were different sites with differing levels of support, then families would have somewhere safe to go, and those with fewer needs could be provided for apart from those who need more support. Each SIP hotel would have a social service coordinator and residents would be screened for untreated mental health issues and need for addiction services. People do not want to live in misery, tortured by their problems. We have a lot of very broken people who need help for not only their sake, but for the sake of the City and society as a whole. 

Beyond housing and shelter, San Francisco should work to support the health of people suffering with mental illness and addiction. People cannot fix their lives unless they are given support and a safe space to do so. If an individual is having a public breakdown in the street, they deserve assistance. Sometimes when people are very ill they do not realize they need help, so mandatory care could be provided in those circumstances. If we actually help people, then the animosity towards the unhoused will fade. The City needs to provide easy access and swift assistance to those who desperately need it. 

Drug prohibition does not work. If we want to stop our streets from being an open drug dealing danger zone, then the only option is to supply drugs to users for free, in a safe environment. Switzerland, Portugal and Canada have had huge success with their safe supply programs. People are using drugs which have been cut with goodness knows what and are of variable strength, leading to massive health issues. Street drugs are impossible to dose, and users often get an experience they didn’t bargain for. There is a lot of moral panic around fentanyl, and its users are unfairly demonized, which does not help anyone. It is also true that fentanyl-tainted stimulants continue to be a problem, and safe supply would mean that no one is getting something they have no tolerance for and did not expect.

Safe supply should mean that no one is left uncomfortable, and that they get what they need, when they need it, in the quantity they need it. In 2003, Insite and Onsite opened in Vancouver, providing a federally legal and fully supervised safe use and safer supply site, alongside detox and addiction services. It was given a federal exemption so it was not subject to Canadian drug laws. More soon followed. There have been zero drug overdose deaths at this or any other safe consumption location.  

Switzerland provides perhaps the best example of how a society used safe supply and safe use centers to solve the issue of open drug use. In the early 1990s, there were considerable issues with use in front of Geneva’s major train station and in front of its most iconic hotel. HIV infection rates were soaring, the parks were full of needles, and local residents and tourists were unhappy. They were in much the same situation as San Francisco is now. Switzerland is not liberal, but it is pragmatic. Policymakers knew they could not stop people from using drugs, so they decided instead to support them. They solved the illegal supply problem by providing a legal and regulated supply of opiates, fighting the problem by making it no longer an issue. After a 1994 law legalized safe supply and safe use centers, crime dropped dramatically, burglaries dropped dramatically, and HIV and Hepatitis C infections fell rapidly. 

There is no reason this system cannot work in San Francisco. Safe use centers are needed. There needs to be a combination of incentive and pressure to use them. If safe use centers were provided throughout the city in places currently favored by drug users, and in return in order to placate the privileged population it was made illegal to use drugs in public, visible drug use on the streets could be made invisible. This way we get the issue off the streets, away from the eyes of tourists, businesses and residents, giving the City the clean up that residents are demanding while also providing compassion and making life possible for those struggling with addiction. 

From a personal point of view, I know that in the long term, safe supply could possibly save my life. I am currently abstinent, but I have been on and off for periods of time. I first used opiates in my teens, and last in my 40s. Abstinence is a dangerous game: Tolerance is lost, but the desire is still there. With the current state of illegal supply there is no way of knowing how much fentanyl is in the heroin available for purchase, and no way of knowing how strong that bag is, or even how strong a portion of that bag is. Hot bags, and hot pockets in a bag, take lives. Falling back into old habits, given the world we live in, would be a death sentence to me. 

I know if I was given medical heroin, I would survive. If I was using street drugs, I don’t know if I would survive even one tiny slip up. People deserve the chance to survive their addiction. Safe supply has been proven to be the key to safer environments all around—both for addicts and for those who are not users. I hope the City looks at what has worked elsewhere and considers taking the opportunity to save many lives. An addict who is not wholly consumed by having to find their drugs and pay for them is someone who can then participate in society and function. What a wonderful thing it would be to save lives and give people the key to live a life focused not on satisfying their addiction, but rather with that need fulfilled, a life that can be full of so much more.  

The problem of human poop on the streets is easily solved: public bathrooms. It is nearly impossible to find a public bathroom in San Francisco which is free and easy to access. Free, easy access to public bathrooms would mean that nobody has to relieve themselves on the street or poop into bags that get left around and make the City unsafe and unsanitary to walk around. 

Concessions on both sides are required in order to fix the issues. It is not difficult to solve these problems. Unhoused people do not just disappear because they are forced to move along. Sweeps are inhumane and do absolutely nothing to solve the issues. Realistically people who have been forced into direct confrontation with society need a combination of incentives and censure, but there is no point in punishing people who have no other choice. Give people safe supply with no barriers, give them safe use centers inside in a building in a few areas of the City, and the issue will decrease dramatically. The dealers will have no one to sell to; after all who is going to use tainted, cut, imprecisely dosed drugs, when safe drug options are freely available to them? 

This needs to be offered in tandem with easy access to detox and addiction services, delivered on demand. There is no point telling a user they are on a waiting list for a detox: By the time that date comes around they will have changed their mind, or may not have survived their addiction. 

We also cannot be squeamish about safe use programs. Yes, cocaine in both freebase and powder forms can be the catalyst for some funky behavior, but without the need to ”earn” that next rock, a lot of the criminal behavior would be reduced. If this is delivered in addition to mental health services, which protect people from themselves while they are unwell, we will see people recover. Those who struggle to recover, or are content to live alongside their addictions, will at least be assisted to live the best life that they can live. It is amazing what people can do when the hunt for their drug is no longer an issue and they can concentrate on living, not just procuring that which they need to live. 

None of this absolutely pleases me. I am not a natural pragmatist, and detest the unfair and unequal justice system. But I also know that in order to make anything good happen we need to win over those rich, privileged people who have no idea what to do, and don’t understand the destruction and pain of the lives of people  who are addicted. They cannot comprehend not having enough money to buy coffee from a shop and being able to use the bathroom, and therefore having to poop in the street. They cannot understand the fact that people will use drugs no matter what, or that the best way forward is not to just arrest more people, but to remove the need to buy the drugs in the first place. All these privileged people see is a person sleeping outside their house, having a mental health breakdown, and making their lives less comfortable. To that end, we are not going to win over these people without offering them the unthinkable: Criminalizing drug dealing after the safe supply system is put into place. 

If we want people who have understandably lost trust in the system to accept a bed in a shelter, shelters have to be decent. We have to provide SIP hotel rooms, SRO options, and privacy. I do not know a single person who would not rather stay in a hotel room than the street, provided they are not hassled half to death and can have their autonomy. Of course people do not want to go into dirty, scary and uncomfortable congregate shelters, where they have no privacy at all. A tent is better than that. If we want people off the street, we have to offer them something better. 

Of course both sides are going to be unhappy. The right wing press would scream that we are giving crack to people for free. Those of us who have been addicted, including myself, would not be comfortable with any kind of criminalization. Very few housed people would want the safe supply and safe use centers to be located near their houses, and there would be those who want the problem solved, want people off the streets, but resent the unhoused being given spaces in hotel rooms. All I can hope is that in the end, more people can be saved, more people can have comfortable and healthy lives, and we can give the City the results they want. A solution that would not please everyone, but would solve the problem and save some lives would be absolutely radical, but I know it would work. It worked in Switzerland, it worked in Vancouver, it worked in Portugal. And the more radical the programs are, with completely safe supply, the better they work. 

The war on drugs cannot be won. We have to fight drugs with drugs. We have to provide concessions on both sides and make some truly pragmatic decisions, but if the main goal is cleaning up the city while helping people I cannot think of a better way forward than SIP hotels, safe use and safe supply programs, and consequences for those who do not cooperate. It is the best possible compromise the City could make for all concerned.