'It's Maddening': Addiction Experts Cry Foul at Mayoral Candidates' Push for Drug Arrests

San Francisco mayoral candidates promising to end drug dealing and use on San Francisco’s sidewalks are increasingly calling for greater law enforcement, putting many health experts on edge as overdose rates persist at epidemic levels.

The increased politicization around the city’s drug response comes as 462 people died from an overdose in San Francisco in 2024 so far — on track for a slight decrease from 2023, when 810 people died of an overdose, the city’s worst year on record. This comes amid an increasingly tense election in San Francisco, where intersecting issues of public drug use, homelessness and safety are top of mind for most voters.

“I don’t think [overdoses] would be as important of an item for politicians if it was just the deaths that are happening, but this is interlinked with homelessness and public drug use, and that’s driving most San Franciscans’ worries,” said Alex Kral, an epidemiologist at the nonpartisan research institute RTI International. “The conversation right now in San Francisco is almost solely reliant on the idea that if we just add more police, we’re going to solve overdoses. And I wish it were that simple, but it’s not.”

While all leading candidates are Democrats, former interim Mayor and Supervisor Mark Farrell represents the most conservative position in the race. During his campaign, he has repeatedly claimed that harm reduction — evidence-based public health strategies aimed at reducing negative impacts of drug use — has “gone too far.” At a recent debate, he said that “neighborhoods are held hostage by open-air drug markets.”

Farrell’s plan specifically targets fentanyl, an opioid about 50 times stronger than heroin and is currently involved in most overdose deaths in the city. He wants to increase arrests for people dealing drugs and call in the National Guard to close down outdoor drug dealing hotspots, like the Tenderloin and South of Market.

His plan includes increasing police staffing to deter public drug use and opening up more abstinence-based recovery beds. Farrell would also try to mandate “treatment-focused detention” for individuals who are revived with Narcan, a medication that can reverse an opioid overdose. His proposal has drug addiction experts deeply concerned. They say that detaining people — whether that’s an arrest or mandated treatment — immediately after reviving them with Narcan could disincentivize people from calling for help or seeking out the life-saving drug.

“There’s no public health rationale for detaining people after they have been revived with Narcan,” Kral said. “You do not want to in any way disincentivize the use of Narcan, and you would potentially be doing that if you are putting somebody at risk of detention, jail, or forced treatment.”

The city directly funds the distribution of hundreds of thousands of naloxone doses each year and encourages residents to carry Narcan in case of an accidental overdose.

A spokesperson from the Department of Public Health said in a statement, “Research shows that community-distributed naloxone is the most effective way to get the medication into the hands of people most likely to respond to an overdose and save a life.”

Laura Guzman, director of the National Harm Reduction Coalition, which works with the city to distribute Narcan and other harm reduction efforts, said that many of the candidates’ platforms simply expand the city’s existing recent approach to overdoses.

“This punishment approach that seeks to correct or make people believe that this will address people with substance use needs is absolutely false, and the fact that we don’t have the kind of treatment that is needed in jail, people could get more sick or even die,” Guzman said. “The same candidates with these platforms are the same candidates whose platforms criminalize unhoused people and poor people in general.”

What’s more, San Francisco still lacks enough treatment options for people who want to change their drug use. First responders issue thousands of Narcan doses a year, according to city data, and respond to dozens of overdose-related calls per week.

“It’s maddening,” Kral said. “We don’t have anywhere close to enough treatment in San Francisco for all the people who actually want it.”

Incumbent Mayor London Breed said the issue is personal for her. Her sister died of a drug overdose, and she’s had to lead the city through the fentanyl crisis, which other major cities across the country have also struggled to contain. As mayor, Breed has opened 394 residential care and treatment beds since 2020, pushed for increased methadone and buprenorphine medication treatments, and city data shows admissions to residential treatment were up 9% during the first six months of 2024 compared to the same time period last year.

In 2021, Breed declared an emergency order to address drugs and overdoses in the Tenderloin neighborhood, which involved creating the city’s first publicly-run overdose prevention center. However, it closed after seven months following criticism from the local business community and ongoing legal challenges at the state and federal level.

This year, she has echoed some of her opponents’ sentiments that harm reduction has gone too far — even as the city’s jails are growing overwhelmed with people struggling with substance use disorder. In March, voters approved a controversial ballot measure, sponsored by Breed, that requires welfare recipients to undergo drug screening and participate in free treatment if they are using drugs.

At a recent mayoral debate, Breed said, “We’re making arrests of dealers. We’re making arrests of users. We’re getting them into treatment, and we’re making more investments in recovery.” In a statement to KQED, she later added: “While I have been a proponent of safe consumption sites, we need to take a different approach now that reflects the lethal introduction of fentanyl.”

Drug addiction counselors and therapists working on the frontlines of the overdose crisis say that their work has become increasingly politicized during the current election cycle, making it harder to secure funding and continue their practice.

Maurice Byrd, a therapist and director of training and business operations at the Harm Reduction Center, said, “Breed started off with a position that was really harm reduction focused.”

“She did seem to implement some things that were really radical, and that helped lower overdose rates,” Byrd said. “Then she got some blowback. I think that’s why this became very political.”

Supervisor Ahsha Safaí — who recently formed an unlikely ranked-choice voting alliance with Farrell — is the only candidate openly calling for overdose prevention centers. At the same time, Safaí is calling for greater law enforcement to arrest drug dealers and wants to expand the city’s abstinence-based recovery options.

“We have to have overdose prevention sites, and we have to expand the number of beds people can get into to fully recover,” Safai told KQED.

Philanthropist and nonprofit founder Daniel Lurie wants to set up a “co-responder” model where behavioral health professionals and law enforcement would respond to an overdose to try to connect people with services in a time of crisis.

Lurie, an heir to the Levi Strauss fortune, also supports increasing police presence downtown to mandate treatment or arrest people who use drugs in public, and he argues the city overall should be coming down harder on drug dealers. Jennifer Johnson, who helped design San Francisco’s existing Behavioral Health Court, has given Lurie her stamp of approval on the plan.

“Simply put, I don’t think we’re going far enough,” Lurie said. “Breed’s administration has failed to hold organizations accountable and produce meaningful results.”

Board of Supervisors President Aaron Peskin, who is in recovery from alcohol, parallels some of Lurie’s approach, including wanting to shut down open-air drug markets with continued police presence downtown and expanding residential drug treatment and mental health care. He supports arresting drug dealers — but argues arresting users “takes away valuable police resources and fills up our already overcrowded jails while doing nothing to address the problem.”

Practitioners comparing the candidates’ plans point to research showing that people tend to have the best outcomes in drug treatment when they enter voluntarily.

Regarding what they would like to see, experts advocate for more policies addressing issues that contribute to mental health and drug use patterns — like access to housing, jobs and health care — rather than pitting public health against law enforcement.

“San Francisco is supposed to be a leader. And it feels like the exact opposite is happening in terms of really embracing the overdose crisis as such,” said Anna Berg, a social worker and director of programs at the Harm Reduction Therapy Center.

“You look back to the HIV epidemic and San Francisco was an innovative leader, and we can do that again,” she said. “I would like to see more leadership centering people’s health and wellness and really offering some actual education.”

This article has been updated to more accurately reflect Farrell’s position on the consequences of drug use.