Here's Why Some San Francisco Nonprofits Give Foil and Pipes to Drug Users

Critics of San Francisco’s approach to the overdose crisis are pointing to a handful of nonprofits that give out aluminum foil, pipes and other supplies to drug users, arguing that they’re only making the problem worse. However, the programs, while they might seem counterintuitive, represent a key strategy for reducing harm and guiding people toward recovery, nonprofit leaders and health experts said.

Harm-reduction programs such as supervised consumption sites and needle exchanges have come under fire in the past. Last week, a report from the San Francisco Chronicle drew attention to the Tenderloin’s Glide Foundation and other city-funded nonprofits for supplying people with foil, pipes and other materials used for smoking drugs such as fentanyl.

People who visit Glide can request these materials during its Syringe Access and Health Hub hours and at its mobile clinics, according to Glide’s senior director of health access services, Mike Discepola.

Once people are there, Glide CEO Gina Fromer said, they have access to recovery services, including a peer-led 12-step program, referrals to detox and inpatient treatment beds, medically assisted treatment options like methadone, and educational materials. In October, the nonprofit plans to open a mental health services clinic.

“Maybe you yesterday said, ‘I’m going to start recovery,’ and you didn’t because addiction is strong, addiction is a disease, it takes a lot to get to a place where you’re ready to get on that recovery spectrum,” Fromer said. “But we want to make sure when you’re ready, you have what you need.”

She told KQED that Glide’s decision to offer foil and other supplies “is really about saving lives and preventing disease, but also creating opportunities for recovery.”

Dr. Amer Raheemullah, the director of the Inpatient Addiction Medicine Service at Stanford Hospital, said such harm-reduction strategies not only make drug users safer but also can urge them to turn to treatment options when made available at the same location as other recovery services.

“The idea is to reduce harm, but then also have this interaction with somebody who’s actively using to slowly nudge them toward treatment,” he told KQED. “That can be through counseling, like a skilled counseling interview that’s been shown to be effective, but it can also simply be by co-locating treatment in the same place that they’re getting these needles or these other harm reduction tools.”

One way to think about harm reduction, Raheemullah said, is to consider those struggling with addiction as having a neurological deficit.

Take someone with Parkinson’s disease, for example — “They might have an increased risk of falls. So, in order to reduce harm, we pad their house; we may make adjustments in their living situation, not to encourage falls, but to reduce the damage of falls if or when they occur. It’s the same with substance use,” he said.

Sharing and reusing needles can increase the risk of contracting HIV and Hepatitis C, which can lead to illness and, in some cases, death.

“The higher objective is to just reduce this harm that’s occurring, preserve life and not do too much damage for later down the line when people eventually accept treatment,” Raheemullah said.

There is also no proof that administering needles or other safe injection supplies increases the use of illegal drugs, he told KQED.

A randomized study of 600 people who injected cocaine, morphine and/or amphetamines found “no difference in the number of injections over time” for people supplied with sterile needles compared to those taught how to purchase them, according to the 2003 report out of the University of Alaska Anchorage.

The Center for Disease Control also said in a February 2024 report that 30 years of research has shown programs that provide access to sterile injection equipment “do not increase illegal drug use.”

Fromer said that Glide’s distribution of safer drug-use materials is one of the nonprofit’s many programs geared toward helping drug users — whether they have chosen recovery or not.

“Anybody walking through our door, we want to have resources and information available to them so they can decide what their recovery journey might look like,” she said. “Or, It might start next week, and we’re going to make sure that you’re not going to die in that week or catch HIV or Hepatitis C in that week.”

Providing clean materials lessens infectious disease spread and decreases overdose risk, Discepola said — if someone were to pick up used foil from the ground or borrow a pipe, they might not know what substances have come in contact with it.

“There could be very small quantities of fentanyl in a device, and if someone doesn’t know it and they think they’re smoking something else, then they could actually overdose and die,” he said.

Handing out clean foil or pipes can also encourage people to smoke instead of injecting drugs, which can be less dangerous because it doesn’t have the same disease transmission risks, Raheemullah told KQED. But there can be a risk in administering foil or pipes to people who have previously used drugs by snorting them, which is considered less addicting than smoking or injecting, he explained.

In general, providing sterile drug supplies is an important tool for addressing the opioid epidemic, he said.

Fromer said that Glide will continue to provide access to those materials — and encourage people to recover.

“We’re going to be talking to them about recovery; we’re going to hint toward recovery,” she said. “Every time you walk into Glide, you’re going to learn about recovery.”