As Overdoses Climb, Lurie Orders Scaling Back Harm Reduction Programs

Mayor Daniel Lurie planted a flag in the overdose debate by ordering the San Francisco Public Health Department to scale back some harm reduction programs as part of efforts to address the city’s drug crisis.

Lurie’s latest move, following the announcement of an upcoming behavioral health facility at 822 Geary for people experiencing a mental health or drug crisis, comes amid nighttime law enforcement raids targeting entrenched drug markets and a steady rise in overdose rates since October 2024, according to data from the Office of the Chief Medical Examiner.

The city is specifically planning to cut back on publicly-funded programs that hand out safe smoking supplies, such as pipes, foil and straws, according to Department of Public Health Director Daniel Tsai, who announced the most recent overdose data at a press conference earlier this week. Clean needle exchanges and Narcan distribution will remain, he said.

Lurie’s directive has sparked controversy among health experts and harm reduction advocates, who say programs that offer supplies for safer smoking are proven to reduce overdoses and infections associated with drug use and can connect users to treatment.

“This idea that if you make smoking supplies disappear, people are going to stop using — it’s a smokescreen and really misguided,” said Laura Guzman, executive director of the National Harm Reduction Coalition.

San Francisco contracts with the DOPE project, a program of NHRC, to distribute Narcan and other harm reduction supplies across the city.

“These directives, unfortunately, are just responding to political perspectives,” Guzman continued.

Fentanyl, an opioid about 50 times more potent than heroin, is the most common drug currently associated with overdose deaths in the city. The majority of fentanyl users in San Francisco and across California consume fentanyl by smoking, which is far less likely to lead to an overdose than injecting.

A recent study found that fentanyl injection users were 40% more likely to experience a non-fatal overdose and 253% more likely to have bacterial or viral infections caused by needle use. While both methods can lead to an accidental overdose, addiction experts say that the shift to smoking fentanyl has likely kept overdose rates from being even higher.

Vladimir Andreyev, who used heroin for several years before turning to smoking fentanyl, has lived on San Francisco’s streets for more than a decade. Craving shelter after a rainy weekend, Andreyev recently stopped by a pop-up triage center on Sixth Street because he heard he might be able to find a shelter bed.

“The only good thing about fentanyl was it helped me get off needles. The needle… that’s really depressing,” Andreyev, 42, told KQED while waiting for a ride to a shelter that a social worker at the center found for him.

Guzman said new fentanyl users tend to smoke.

“Smoking supplies, in particular, engage communities that are not already engaged in needle exchange programs,” she said. “So that directive goes contrary to all evidence.”

Lurie’s administration is doubling down on law enforcement to disrupt outdoor drug markets.

“We are actively dismantling the illegal drug markets as part of our ongoing commitment to public safety. San Franciscans deserve safe and clean streets,” he posted on social media platform X on Thursday, after police arrested nearly 40 people for being near an outdoor drug market at Market and Van Ness streets.

It’s the third overnight raid the city has carried out in recent weeks. Police surveillance has also increased on Sixth Street and near the 16th Street BART station. Some residents and officials have applauded the crackdown for at least temporarily clearing chaotic public areas.

“If you drive by there now, things are definitely better,” Supervisor Stephen Sherrill said at a recent press conference, referring to an overnight drug market raid that led to dozens of arrests at Jefferson Square Park. “Residents are rightfully hesitant to declare victory, and I don’t think anybody here is ready to declare victory at all.”

Police and supervisors have said that the actions have pushed dangerous activity to other areas, and they are developing longer-term deterrence strategies.

Andreyev, who sleeps outside near Sixth Street, has noticed the changes.

“It’s cleaned up a lot. I’ve had a lot of friends get arrested,” he said. “You just have to be careful and follow the rules [if you] don’t want to end up in jail.”

Overdose rates fluctuate, and no specific intervention can be easily attributed to increases or decreases on a month-to-month basis.

A spokesperson for the Department of Public Health told KQED that what matters is that overdose deaths “are preventable, and we must have a quick, accessible and effective treatment and sustainable recovery” to drive rates down “and make our communities healthier.”

Multiple health experts said they are concerned that winding down some harm reduction programs while increasing enforcement could lead to a sustained increase in overdose rates.

A study released this week by RTI International, a nonpartisan research organization, found that overdose risk was significantly higher in the days shortly after police seized drugs in San Francisco. The study looked at time and location data for both police drug enforcement actions and overdose deaths from January 2020 to September 2023.

That increased risk can be due to a variety of factors, including, as the study points out, if a drug user looks for a new supply after a drug bust, they could accidentally consume something more potent than their tolerance is used to.

“These findings suggest that the enforcement of drug distribution laws to increase public safety for residents in San Francisco may be having an unintended negative consequence of increasing opioid overdose mortality,” the study concluded.