Where did San Francisco go wrong in its approach to the drug and homeless crises? Is it bad policy? Well-intentioned but misguided philosophy? Yes. But it’s also the dismantling of infrastructure and accountability with no replacement.
In 2018 I found myself homeless and living on the streets of the Tenderloin. Mainly on the 300 block of Golden Gate Avenue. I had made a fateful choice. My addiction to heroin (and later fentanyl) had won. I left my wife and kids after being given an ultimatum to seek treatment or leave the home because I was terrorizing my family and had bankrupted us by spending thousands of dollars on opioids on the street. I went to the block where just a few months earlier I was a drive-up customer buying heroin and crack from organized drug dealers. That street became my new home. The drugs won.
As I began my life on the street, I quickly realized everyone was engaged in some type of hustle. A hustle motivated by drugs. Boosting from Walgreens, Safeway, CVS, Target, and if you were bold, Ross on Market Street, were regular occurrences. Also, accessing benefits was a priority. General Assistance and SNAP benefits were a primary means of not only survival, but of supporting my and many others’ drug addiction.
I didn’t know where I could access drug treatment even if I wanted to.
For some “lucky” ones like me, we were engaged by the street dealers to hold their stash on the street. In exchange, we were paid in heroin, crack (and now, fentanyl). I guess I looked trustworthy. I was 47, and probably wasn’t going to run off with their stash. They were right. Within three months, I was holding for six different dealers at various times of the day. This designation did two things: supported my drug addiction because I was paid in drugs (almost never cash) and protection. Because I was a “holder” I didn’t have to worry about being robbed or other things because I had some value to the dealers on the street. That was my hustle.
Others had to resort to darker forms of work including boosting and for some young women and men, sex work. I quickly realized the sad reality I was now stuck in. Any hope of seeing my wife and kids again slowly faded. Why? Because there was no help there. Nobody was coming to my aid. I didn’t know where I could access drug treatment even if I wanted to. I heard of places like The Salvation Army and I thought, isn’t that the place where you drop off old clothes?
The outreach I did receive came in the form of three things:
Police. Even today, they do most of the outreach to the homeless and drug addicted on the street. Every morning, the U.C. Law S.F. police would come and wake us up at 5 a.m. and make us move across the street because they had to clear their side of the block, but the other side was SFPD’s job, and they were more lax.
Faith-based organizations. Almost every Sunday at 6 a.m. members of a Korean church would show up in a van with coffee and donuts and preach about how we were sinners and needed to repent. Or, sometimes another Christian organization would come with sandwiches or McChicken sandwiches and would pray over us for salvation.
Harm reduction workers walking around with a wagon handing out drug and sanitation kits. These “hygiene kits” contained a clean syringe, cooker, tourniquet, push rod, Brillo for my crack pipe (there were no free pipes and straws and foil then), and you had to make $3 to buy a pipe. They also passed out condoms. That’s it. No one ever in the six months I was out there asked me about treatment except the police.
Add to this reality that most people on the street are in crisis including uncontrollable hallucinations of being gang stalked because of meth-induced psychosis, young people (especially women) being exploited for sex because of their addiction, watching dealers break a man’s arm and hack him with a machete because he was in withdrawal and begging for credit to be extended for drugs. But because he already owed money, the dealers just beat him up. You get an idea of life on the street.
As I was nearing the end of homelessness in May 2018, a new drug, fentanyl or “fenty,” started showing up. But not from the Honduran dealers. It was being sold by an older white guy from his car who told us he would get it in Oakland. One of the dealers asked me, “Why is everyone on the block high, and I haven’t sold any heroin?” The answer was fentanyl. It was here, and it would change everything. I remember the first time I smoked it. It was the only time since the first 30 mg of oxycodone I took in 2015 that I felt that high. I couldn’t control my leg movements and wound up in crouched in a doorway for two hours fading in and out of consciousness. I loved it. You could inject it, smoke it, inhale it, it didn’t matter. It got you higher than heroin ever could.
A month later, I was off the street and in jail. I spent the next three months in custody and six months in rehab and my life forever changed. For the better.
Fast forward to 2024 and much has changed. Illicit fentanyl took over the streets. All the dealers sell it. Heroin has disappeared. We also lived through a pandemic, elected and then recalled a radical district attorney who did not believe that accountability was a pathway for people exiting addiction or the streets, 3,000 overdose deaths, and a much more radical interpretation of “harm reduction” that places the focus on “supporting drug users.” San Francisco also (until recently) had removed the police response to drug users on the street and treatment became all but voluntary. While that sounds good, it’s not. Without incentives and accountability, people just continue to use. Except now — they die because fentanyl is 100 times stronger than morphine. The city is now spending millions per year on syringe access programs that include pipes, foil, and straws that are given out freely on the street along with over 700,000 clean needles. Is the problem better? I think we can make a strong argument that we’ve made it worse in the name of compassion.
In 2024, the city is still in an unprecedented crisis. And despite the mayor declaring in 2021 a state of emergency in the Tenderloin, and after $22 million spent on a “linkage center,” the problems remain. I recall Mayor Breed making a strong speech, declaring changes that she would be “more aggressive with changes in our policies and less tolerant of all the bulls–t that ha[s] destroyed our city.” I was excited. The thought of accountability returning to San Francisco gave me hope. After all, accountability is a cornerstone of recovery. People were angry. HealthRight360 held a press conference with the former district attorney Chesa Boudin decrying this as a “return to the war on drugs” and vowed not to support this declaration by the mayor. Then, suddenly, Breed turned the operation of the Tenderloin Linkage Center over to HealthRight360 and the Department of Public Health, and dropped “linkage” from the title and poof! It became a supervised injection site and less than 2 percent of the thousands who accessed it were referred to drug treatment.
The one positive? The Feds. In 2023, under pressure, Speaker Emerita Pelosi and Governor Newsom asked for “Operation Overdrive.” An Initiative from the Department of Justice that targets high drug trafficking cities. In addition, Governor Newsom sent in the California Highway Patrol and logistical support from the National Guard. In that time, over 900 drug dealers were arrested, and hundreds of pounds of fentanyl were seized. But, alas, the courts let most of the dealers out of custody pending court hearings and they went right back to the street to sell drugs. Still, the Feds arrested over 150 dealers, which brought federal charges. Those dealers do not return and are subject to deportation.
What’s the solution? Sustainability and infrastructure. We must keep up the enforcement indefinitely, while at the same time allocating additional funding to build out drug and mental health treatment. (This is why I voted yes on Proposition 1. We must start somewhere.) In the meantime, it’s my job to tell the truth and to keep the pressure on to change the narrative to one of accountability and recovery. The harm reductionists had their chance. And they failed. It’s time for recovery to take center stage in the battle for the soul of San Francisco.