“People are fed up with it,” said San Francisco Police Chief Bill Scott at a news conference on Friday. “We are fed up with it. And our attention needs to be on the people who are causing the problems, not on each other.”

But the emphasis on law enforcement for addressing the city’s drug crisis has distressed public defense attorneys and harm reduction advocates who fear the move may worsen the rate of fatal overdoses.

“Right now, we’re losing four people a day to overdose deaths on the street, and that’s up from two a day from last year,” said Sujung Kim, an attorney at the San Francisco Public Defender’s Office. “Driving everything underground is part of what makes it so unsafe.”

Kim said she would love to see fewer people addicted to drugs, but cracking down on street level dealing will only worsen fatalities because people will be less likely to call 911 for fear of arrest, and it will drive drug users to buy from unfamiliar sources, heightening the risk of overdose.

Research has shown that incarceration increases risk of overdose. According to a study by the Oregon Health & Science University, Oregon State University and the Oregon Department of Corrections that was published last month in the Journal of Substance Use and Addiction Treatment, people recently released from incarceration face a risk of opioid overdose 10 times greater than the general public.

Gov. Gavin Newsom’s announcement on April 21 that he was sending the National Guard and Highway Patrol to San Francisco stated that the new law enforcement partnership would not target drug users, only drug dealers and traffickers.

Scott reiterated that the operation would target drug dealers. But he suggested that police would also focus on open drug use, saying, “It’s not OK — not only to deal drugs on the streets, but to use drugs on the streets.”

Matthew Beevers, deputy adjutant general of the California National Guard, said at Friday’s news conference that he wanted to “dispel rumors” that the military’s involvement would include “boots on the ground in San Francisco.” Instead, he said, the soldiers and airmen would synthesize information gathered by all enforcement agencies into “actionable information that we can map.”

They would track “cartel networks both operating in the city and outside the city — understand those networks, build a common operating picture of it, and then work to dismantle those networks,” Beevers said.

Gary McCoy, vice president of policy and public affairs for HealthRight 360, which is contracted to run numerous harm reduction programs in the city, said he understood the pressure facing city officials and law enforcement, but believed it to be the wrong approach.

“I think that folks are just very frustrated with where we’re at right now, with what they’re seeing that’s more visible in the streets,” McCoy said. “But really, the challenges that we’re seeing on the streets right now are largely due to the war on drugs, and it’s been the punitive approaches to people who use drugs and the high rates of incarceration.”

McCoy advocates reducing drug demand by stepping up access to long-term treatment, and by taking a more forgiving approach to recovery, in which individuals are not kicked out of residential treatment facilities for briefly returning to drug use. He added that 90-day residential treatment programs were not enough to get people with substance use disorder stabilized. Although a new two-year “step-down” facility just opened on Treasure Island offering 70 spots, a lot more is needed, he said.

“The ideal number of step-down beds would be three to four times the amount of residential treatment beds, because you’re cycling more people out of residential treatment,” he said. “We’re getting there. The city’s made fast improvements to that stock.”

There are currently a total of 245 residential treatment beds in San Francisco and 193 step-down beds.

Studying Divergent Approaches

Alex Kral is an epidemiologist with independent research institute RTI International who has been studying harm reduction programs for more than 30 years. Kral said he was baffled by the law enforcement approach because no research has shown that expending resources and efforts on reducing drug supply has led to either reduced demand or reduced health complications related to drug use. Since the adoption of the Controlled Substances Act of 1970, he said, resources dedicated to drug supply law enforcement have “far outspent” measures to prevent drug addiction, provide treatment and reduce harm. Meanwhile, “We’ve just seen things get worse and worse and worse.”

“I get it,” Kral said. “If you don’t understand much about drug use or drug markets or any of that, it makes sense to me that people are like ‘Well, if we just prevent there being drugs in the community, it will stop.’ But this is not how it’s ever worked in any society in the world. And definitely the U.S. is a prime example of a place where this has turned out miserably for 50 years.”

In 2008, the Brookings Institution analyzed three approaches to global counternarcotics policies: “the punishment model” of the U.S., which uses incarceration to deter use; “the depenalization model” used in Italy and Spain, which keeps illicit drugs illegal but does not punish personal use below certain amounts; and “the decriminalization model” used in the Netherlands. Findings were most critical of the punishment model of the U.S., where incarceration rates have soared — to more than 350,000 in 2023 from fewer than 50,000 people in 1980 — costing billions in taxes while few prisoners have access to any form of drug treatment.

Drug courts, which were meant to divert defendants into treatment, largely failed at providing treatment to those who truly needed it, and filled up limited spaces with court-mandated patients who did not always need the care, according to research by Physicians for Human Rights.

Mayor London Breed said at Friday’s news conference that the operation in San Francisco differs from the war on drugs of the 1980s, because back then, “everything was about arrest, lock people up.” Now, she said, the city provides “extremely generous” social services.

Nevertheless, the Public Defender’s Office has seen increased prosecutions for low-level drug sales, which are “filling up our jails,” Kim said. And defendants are often subsistence drug dealers, meaning they sell drugs to fund their own addictions.

District Attorney’s Aggressive Tactics

Andi Gernaey is harm reduction director of the St. James Infirmary. Gernaey leads a team that travels by van to the Mission District to distribute hygiene kits, harm reduction supplies, food and other necessities.

Gernaey said the crackdown is in keeping with “draconian” measures from law enforcement that have been seen since Brooke Jenkins took over as San Francisco’s district attorney, including installing barriers along certain streets in the Mission to disrupt sex work.

“A lot of time they just use it as an excuse to harass people and search people and detain people, and then they end up not filing formal charges because they’re more like nuisance charges than what holds up in court,” Gernaey said.

Not knowing what’s planned for the stepped-up enforcement is causing anxiety among the team members, who worry that officers will not understand what they are doing there. Gernaey said they advised the team to be wary.

“If we are approached by police or military,” Gernaey told the workers, “just like, don’t say anything, say you’ll get your supervisor, and then I’ll talk with them because we’re allowed to do what we’re doing.”

Sean Duryee, commissioner of the California Highway Patrol, said at Friday’s conference that his officers would be patrolling and executing arrests. He did not disclose the number of officers involved in the operation but said that 75 officers are currently assigned to San Francisco with nine more arriving in June.

Jenkins said the operation would help combat the “human trafficking defense.” She said suspects often speciously claim to have been forced into selling drugs under threats to them or their families.

“I am very excited at the prospect of having additional resources to be able to dispel the notion that people are not here dealing drugs of their own accord, because that is clearly what is happening,” Jenkins said.

Kim said that as an attorney at the Public Defender’s Office, she had heard “horrific” firsthand accounts from people arrested for dealing drugs, some as young as 17, who had witnessed gang violence in Central America and knew what MS-13 was capable of.

“Brooke Jenkins could deny all she wants, but two of her attorneys lost cases last year where the juries heard their stories,” Kim said. “One of them, they had to pay coyotes to come over here to escape violence, and they were under threat of death, forced to sell drugs. And the juries believed the defense. I’m not saying it’s every single case, but it happens more often than people might know.”

This article is part of a series on San Francisco’s overdose crisis and prevention efforts, underwritten by a California Health Equity Fellowship grant from the Annenberg Center for Health Journalism at the University of Southern California.

The post Military-Style Drug War in Tenderloin Sparks Fears That More Drug Users Could Overdose appeared first on San Francisco Public Press.

These tragedies were disproportionately suffered by marginalized groups. The biggest increase in deaths occurred among those who lacked housing. People listed as having “no fixed address” accounted for 61 overdose deaths in the first quarter, up from 26 during the same period in 2022. Black residents accounted for 33% of fatal overdoses in the first quarter this year, despite representing only 5% of the city’s population.

Addiction experts say the recent increase in overdose deaths could be linked to the closure of the Tenderloin Linkage Center, a temporary facility that operated in United Nations Plaza from January to December 2022 to help drug users and people without housing access supportive services.

Gary McCoy is vice president of policy and public affairs for HealthRight 360, the organization that ran health services for the Tenderloin site. The center also became an unofficial overdose prevention center, and McCoy connects the rise in overdoses to its closure.

“When TLC was open, and we had a safe place for folks to go, the numbers went down,” McCoy said. “So yeah, it’s pretty telling data.”

Department of Public Health statistics showed that from January to November 2022, the center received 100,000 visits and reversed 300 overdoses. Despite those results, the city shut down the site a month earlier than planned in part due to complaints from business owners and residents who said that drug use and dealing increased after the center opened.

City officials planned to open more supervised consumption sites as part of San Francisco’s 2022 overdose prevention plan, but City Attorney David Chiu advised against this since state and federal laws prohibit them.

Five days after the medical examiner’s report was released, Gov. Gavin Newsom made an unannounced tour of the Tenderloin with state Attorney General Rob Bonta. In a video posted online Wednesday, Twitter user JJ Smith approached Newsom as he strode down Ellis Street, asking him what he was doing about the fentanyl crisis.

“That’s why we’re here. You tell me what to do,” Newsom said as he continued walking.

The health department did not address questions about a link between the closure of the Tenderloin Center and a rise in deaths. Instead it emailed a response pointing to measures the city is taking to address the overdose crisis, including distributing more than 5,000 kits of the overdose reversal drug naloxone and the recent opening of a 70-bed residential facility at Treasure Island for people transitioning out of treatment programs.

State legislators passed a bill last June that would have allowed supervised consumption sites in San Francisco, Oakland and Los Angeles, but Newsom vetoed it in August, saying he would not back such a move “without strong, engaged local leadership and well-documented, vetted, and thoughtful operational and sustainability plans.”

Alex Kral, an epidemiologist with independent research institute RTI International who has been studying harm reduction programs and supervised consumption sites for more than 30 years, called Newsom’s decision “disappointing.” In recent years, Kral provided expert testimony on their effectiveness in public hearings at City Hall and in Sacramento. 

“A couple of years before that, when he was campaigning, he said he would sign such a law,” Kral said. “And then he went back on it. And, you know, that was really a shame. And it’s really set us back.”

Kral said he provided San Francisco’s heath department with results of his study of the Tenderloin Center, which showed that it did not increase public drug use or the prevalence of discarded paraphernalia, but that it did reduce drug-related emergency department visits.

Nevertheless, Mayor London Breed expressed disappointment in the Tenderloin Center because fewer than 1% of its clients were provided opportunities to enter treatment.

In December 2021, Breed declared a “state of emergency” authorizing a crackdown on drugs in the Tenderloin. A few months leading up to the linkage center’s closure, police began leaning into a more punitive approach, which Breed lauded in a recent blog post, noting statistics showed that from Oct. 1, 2022, to April 6, 2023, police made 379 arrests for drug possession or sale in the Tenderloin.

But McCoy said the subsequent rise in overdose deaths shows that cracking down on possession is not an effective method for reducing drug use or the harm it causes.

“We’ve increased enforcement, police officers have been arresting and citing people for using drugs and having paraphernalia, the district attorney has increased her punitive efforts,” McCoy said. “And the rates of cases charged for people who use drugs, and our numbers, are going up.”

Furthermore, he said, focusing on the number of people who enter treatment is not an accurate measure of success.

“It takes consistent contact and communication to have those conversations,” he said. “It’s not overnight, although it could be sometimes, but it’s often not.”

During the last days the center was open, people who had been placed in housing and received services returned to express their gratitude.

“They were coming in on the last day, and bringing us flowers and thank you cards,” McCoy said. “It was very emotional.” He said some of those who received assistance were, “upset that what had helped them is no longer going to exist for other people.”

Former client Adriel Cota said the center helped by giving him clean drug consumption supplies. Staff were on hand to reverse overdoses should the need arise. But Cota said he was acutely aware of the perception caused by all the medical emergency activity at the center.

“I know there were a lot of ODs here,” he said. “Paramedics were here almost on the daily but, you know, that’s kind of what this was for. Out of all the ODs I know, everyone survived.”

Cota, who does not have housing, said the center provided him with services that were unavailable elsewhere, were located far away or limited access to once or twice a week.

“Here, every day they had food,” Cota said. “If you would take a shower, they’d wash your clothes, and before you go, get out of the shower, your clothes will be ready. Now, I’ll have to figure it out as best as I can.”

This article is part of a series on San Francisco’s overdose crisis and prevention efforts, underwritten by a California Health Equity Fellowship grant from the Annenberg Center for Health Journalism at the University of Southern California.

The post With Overdose Deaths Surging, Critics Chide City, State for Curbing Safe Consumption Centers appeared first on San Francisco Public Press.