SF’s Top District 5 Candidates Outline Bold Plans to Tackle Drug Crisis in Tenderloin

San Francisco’s Democratic Party endorsed Bilal Mahmood for District 5 supervisor on Wednesday night.

The vote for Mahmood, an elected member of the Democratic County Central Committee, occurred just hours after Speaker Emerita Nancy Pelosi announced she was endorsing incumbent Dean Preston.

Whether the district is represented by Preston, Mahmood or Autumn Looijen, another top candidate, might be determined by how voters feel about the Tenderloin, where San Francisco’s drug epidemic is on full display.

Last year was the deadliest on record for overdose deaths in San Francisco when the city recorded 810. As of June, there have been 374 accidental overdose deaths in 2024, according to data from the San Francisco Office of the Chief Medical Examiner. Almost a quarter — 21% — of overdoses have occurred in the Tenderloin.

During 2022’s redistricting, the Tenderloin was added to District 5, which now includes Japantown, Western Addition and Haight Ashbury. The overdose data and discontent over street conditions make Preston vulnerable in his reelection bid.

City leaders have tried to address the drug crisis. In December 2021, Mayor London Breed issued a state of emergency, and in May 2023, her office launched the Drug Market Agency Coordination Center to streamline efforts by local law enforcement and other city departments to shut down open-air drug dealing in the Tenderloin and South of Market neighborhoods.

Mayoral candidates Daniel Lurie and Mark Farrell have promised to implement similar emergency plans if elected. Both target fentanyl, which accounted for around 80% of overdoses in 2023 and 71% this year.

Preston, Mahmood and Looijen have also announced proposals.

Preston has advocated for the city to adopt the “Four Pillars” strategy, an approach to combating addiction developed in Europe in the 1990s. At an April event, Mahmood said he would advocate for drug market intervention, a strategy developed by the U.S. Department of Justice. Looijen announced her “Fenta-NIL” plan in May.

Keith Humphreys, who worked as a senior policy adviser in the White House Office of National Drug Control Policy during the Obama administration, weighed in on the candidates’ approaches.

Dean Preston

Preston, the only democratic socialist on the Board of Supervisors, has faced criticism over his handling of the fentanyl crisis since his district absorbed much of the Tenderloin. He has butted heads with moderate officials, including Breed, who believe increased policing is necessary.

Both Mahmood and Looijen have pointed to Preston’s apprehension to support arresting fentanyl dealers, adding that he dismissed the approach as pointless in 2023, according to The San Francisco Chronicle.

Preston denied the assertion. He said that the “Four Pillars” strategy — prevention, treatment, harm reduction and enforcement — includes policing.

“Our approach includes enforcement of laws against fentanyl dealing and targeting and disruption of the fentanyl supply,” Preston told KQED.

The policy promotes collaboration between law enforcement, social service providers and public health officials as equal partners. The goal is to use police enforcement to maintain public order and lower barriers to treatment and harm reduction resources.

“I like that idea of recognizing all four pillars as valuable. I don’t think we’ve had enough of that,” said Humphreys, who advises Congress on strategies for reducing drug addiction.

The Four Pillars were first implemented in Switzerland and resulted in a 50% decrease in overdose deaths in the country by 2010, according to the Stanford Social Innovation Review.

Another priority for Preston is opening more safe injection and overdose prevention sites, like the defunct Tenderloin Center that was introduced as part of Breed’s 2021 state of emergency. Preston blames Breed for closing the center in December 2022 and increasing the policing of drug users.

According to data released by SFPD, law enforcement officers arrested 1,284 drug users and 1,008 drug dealers during the drug market coordination center’s first year of operation.

“We’ve arrested almost 1,000 people for the ‘crime’ basically of being addicted to drugs instead of addressing it as a health crisis or a criminal law enforcement issue,” Preston told KQED. “That doesn’t do anything. Studies show it increases overdose deaths.”

He said the city should open more wellness hubs like the Tenderloin Center. The Department of Public Health’s Overdose Prevention Plan, released in 2022, said that at least two should have been established within two years. Despite requests from his office, none have opened, Preston told KQED.

Humphreys said that overdose prevention sites do offer a safer place for those who use them, but the sites can be expensive, and the city could get better output for its money with a different strategy.

“They don’t touch much of the population,” he said of the sites. “The people who use them don’t tend to use them very much, and people who use them also don’t seem to change their behavior much outside the site.”

Bilal Mahmood

Mahmood announced his plan to address the drug crisis alongside District 6 Supervisor Matt Dorsey at a campaign event in April. Both are supporters of drug market intervention, a strategy that has been implemented in cities across the U.S.

Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, said the DMI approach is “long overdue to try in San Francisco.”

“It doesn’t get rid of drugs, but it does get the dealers off the corner, which has all kinds of good benefits,” he said. “Kids can walk to school more safely. The whole neighborhood feels really different.”

DMI has three components: incapacitation, deterrence and prevention. Mahmood, who California Attorney General Rob Bonta endorsed, said that the first step of DMI is identifying and building cases against drug dealers.

Dealers are then presented with the evidence against them and offered one chance to quit before drug markets are shut down, according to Humphreys. Anyone who is arrested for dealing drugs after the initial crackdown faces prosecution and potentially jail time.

“You can get people to leave [drug dealing] on their own, save a lot of money, a lot of time and a lot of lives,” Mahmood said.

Identifying dealers, building cases, and eventually, keeping markets closed requires collaboration between local law enforcement, prosecutors and community members. This can make DMI challenging since law enforcement and the communities they police often distrust each other, Humphreys said.

“Sometimes there has to be some atonement,” he told KQED. “It often has to begin with police saying, ‘We’re sorry that what we’ve been doing hasn’t been working, about many bad incidents that have happened over the years, but we want to have a good relationship and work with you.’”

Mahmood also supports the drug-free housing legislation proposed at the city level by Dorsey and Supervisor Rafael Mandelman. The legislation would require the city to create more drug-free recovery housing.

Autumn Looijen

She gained notoriety after co-leading the recall of three San Francisco school board members in 2022. She also launched SF Guardians, a political action committee with an associated program that trains candidates running for office. She said that DMI would be a part of her “Fenta-NIL” plan, which calls for cutting drug supply and demand, cleaning streets and adding beat cops to the Tenderloin.

“Anyone choosing to deal drugs to our people after that day would be immediately arrested and sent to federal court,” Looijen told KQED.

Humphreys said that most drug dealers’ cases will likely be handled at the city and state levels.

“Federal resources in this area are limited and have to be carefully prioritized,” he said. “Although it is often possible to charge low-level drug dealers under federal law, most federal prosecutors would prefer to devote their limited resources to big fish.”

Looijen’s plan also calls for more drug-assisted treatment beds and clearing neighborhood blocks of drug use. She also supports Dorsey and Mandelman’s proposal.

Humphreys said that having streets free of drug sales and use would be a good indicator of whether the city’s efforts to suppress drug markets were successful.

Looijen told KQED that she would also advocate for increased penalties for dealing drugs in the proximity of treatment centers and sober living housing. The penalties would be similar to a policy introduced in 2022 by District Attorney Brooke Jenkins that considers enhancements for drug dealing within 1,000 feet of schools.

She is the only candidate who has said she would support compelled treatment as a last resort when drug use is affecting the community.

“Everything has to be on the table,” she said. “I don’t like the idea of having to arrest drug users, but I think it does need to be in our pocket as a last resort to get them into treatment. I realize that forced treatment has a much lower success rate, but that rate is not zero.”

Humphreys said that coerced treatment has mixed results at best. While some people do respond to compelled treatment, it’s generally not a pathway for sustained recovery.

Some research has found that coerced treatment can actually increase overdose risk after the treatment course has ended. Research published in the Society for the Study of Addiction in 2019 found that involuntary treatment was associated with an increased risk of non-fatal overdoses for those who inject drugs.

“That’s a strategy of last resort after we’ve implemented extensive low barrier and culturally appropriate voluntary treatment,” Humphreys said. “I think the city has done a decent job, but in the treatment system, there’s still a long way to go.”