For decades San Francisco’s harm reductionists were considered the good guys. Certainly on the surface they appeared to be the saviors, distributing an endless supply of clean needles to the city’s down-and-out intravenous drug users. By doing so they could mitigate the spread of such devastating diseases as HIV and Hepatitis C.
However, the tangled web of organizations supported by the San Francisco government — including the San Francisco AIDS Foundation, Homeless Youth Alliance, and Glide — began to dramatically expand their offerings. In addition to providing millions of syringes, they began to distribute a vast array of other drug use items with tenuous positive benefits.
As far back as 2018, At the Crossroads had been assembling and distributing “safe cocaine snorting kits” to San Francisco-based youths. These baggies contained straws, razor blades, chopping mats, and snorting instructions.
Working under the umbrella term of “harm reduction,” the activists started to give out glass pipes to smoke methamphetamine and crack cocaine. How could such items prevent the spread of disease? They provided well-made pipes that would lead to fewer cuts on lips, which would then abate the transmission of blood-borne illnesses … uh, sure.
But if giving out free cocaine, meth, and crack paraphernalia did not stretch the boundaries of rational thought sufficiently, the way these activists began to respond to San Francisco’s worst drug crisis in history — the rise of fentanyl — went far beyond any sane person’s imagination.
By 2020, fentanyl had taken over already beleaguered parts of the city such as the Tenderloin and Civic Center. Black market oxycodone pills and heroin had given way to the highly toxic and addictive synthetic opioid. Rather than a declining overdose rate, people began dying in record numbers. In the years between 2020 and 2024, 3,460 people lost their lives to fentanyl in San Francisco.
That same year, the Department of Public Health, in partnership with the National Harm Reduction Coalition’s DOPE Project launched the “Know Overdose” campaign. Billboards displayed happy people about to tuck into some meth and fentanyl. All would be fine as long as they got high with friends. The campaign was quietly pulled after public outcry and an embarrassing barrage of national and international news stories. It was even criticized by the New York Times.
Soon signs of disaster were highly visible throughout the city. It was impossible to avoid seeing countless people bent over, frozen in time, or collapsed on the street. The agonizing tragedy was becoming unbearable and defied common sense. Nearly everyone who witnessed the scenes began to have the same horrified reaction: This is not right. Something is very, very wrong. What the hell is the city doing?
Instead of addressing the suffering and deaths of drug addicts by promoting recovery, the harm reductionists have offered free drug supplies.
Still, instead of addressing the suffering and deaths by promoting recovery, the harm reductionists just added fentanyl smoking supplies to their menu. Even they couldn’t come up with a decent explanation as to how foil and straws would be advantageous, so they deferred to tropes about how providing the supplies stopped the stigma.
It’s hard to pinpoint exactly when the public fully turned on the harm reductionists. After a series of bad decisions, faith in their expertise was all but shot. The proverbial nail in the coffin, though, may have been the white mobile vans.
Initially the harm reductionists distributed supplies from brick and mortar locations. Anyone could walk up and request whatever they wanted. It was easy. In 2020, I went undercover as an addict for City Journal to investigate. From various pick-up points I received bags of drug use supplies. No one asked me if I was O.K. or wanted treatment. No one checked my I.D. I was wearing a mask, wig, and sunglasses, so was totally obscured. For all they knew, I could have been a kid.
Then harm reductionists began driving to where the drug users often congregate, such as behind Safeway in the Castro. Starting in the late afternoon, they pull up, take out collapsible tables and set up a smorgasbord of items — including foil and straws for fentanyl and the extra special glass pipes for meth and crack — all free for the taking.
In 2024, a few independent journalists and I accompanied a German news crew to witness the operation. It was shocking. Their assessment was the same as the locals: This is not right. Something is very, very wrong. …
The answer, it seems, is finally putting an end to the madness.
On March 17, 2025 Mayor Daniel Lurie announced his administration’s Breaking the Cycle initiative.
Notably, the detailed plan that addresses the intersection of addiction, mental illness, and homelessness “reassess policies for distribution of fentanyl smoking supplies in public spaces and refocuses on access to long-standing evidence-based public health interventions (such as clean needle exchanges) alongside strategies to connect individuals to evidence-based treatments and recovery strategies.”
Not quite far enough for many San Franciscans who want harsher, stronger action but chilling words for the radical harm reductionists. Where would they go, what would they do?
The answers are, in fact, exciting. They have the opportunity to transform not only their mission but peoples’ lives. Because they have vans, they can drive around the city and give basic and immediate medical care. They can spend time trying to convince addicts to take advantage of detox and recovery services, such as Salvation Army’s The Way Out program, then personally provide the transport.
We reached out to the San Francisco AIDS Foundation about the changes to the drug supply policy. Unfortunately instead of saying they are looking forward to embracing the initiative, their official response was “no comment.”
There is much more on the horizon, too. Drug-Free Sidewalks has just launched, and sober housing for people who transition out of recovery is coming.
As for the hardcore harm reductionists, the switch from hero to enemy must indeed be a hard pill to swallow.