SAN FRANCISCO, CA – On Friday, August 4, Supervisor Matt Dorsey wrote to Mayor London Breed, urging her to cut the recently approved City funding for Wellness Hubs and reallocate the money to “jail-based treatment and recovery services.”[1] Moving money from desperately needed voluntary street-based resources in favor of criminalization and ineffective access to care through the criminal legal system is at the core of Supervisor Dorsey’s proposal, and HealthRIGHT 360 strongly opposes this notion in its entirety.
Problematic substance use and fatal overdose are priority public health issues that rightly deserve effective, evidence-based interventions. This does not include the arrest, incarceration, and coerced treatment of people who use drugs solely for public intoxication and having no safe place to go; however, it is especially egregious when it comes at the expense of resources intended to serve the most vulnerable members of our community. Reallocating any funding designated for Wellness Hubs would be misguided and shortsighted.
“I applaud, too, your authorization for SFPD to begin making arrests of those using drugs in public.”
The War on Drugs, which this regressive law enforcement-first approach irrefutably represents, and the criminalization and stigmatization of people who use drugs, have resulted in generational harms, abhorrent racial disparities, overfilled our prisons, and led to increased distrust of police. This type of policing is also shown to exacerbate overdose rates.[2][3] Criminalizing the drug supply and consumption in an effort to reduce them is precisely what has led us to this point.[4] What it has not done is reduce substance use in any meaningful way. Since the closure of the Tenderloin Center – coupled with a lack of continuity of a similar model of care – San Francisco officials have increased enforcement and arrests of people who use drugs, increased charging rates, and reduced opportunities for diversion.[5][6][7][8] This escalation in punitive approaches and criminalizing drug use, and lack of consultation, communication, and coordination with the City’s providers who work with people who use drugs, has contributed to a record 406 accidental overdose deaths in the first half of the year – 101 more than the 305 that occurred during the first half of 2022 – and 191 arrests for drug use, zero of which have resulted in people accessing treatment in jail.[9]
“This new approach has also brought to light troubling revelations about the massive scale of drug tourism we now face, with the vast majority of those arrested for public drug use in our city having out-of-town addresses.”
This is not a new approach.[10] The latest San Francisco Office of the Chief Medical Examiner’s Accidental Overdose Report, dated July 14, reveals that most of the people who were housed and died of an accidental overdose in San Francisco were local. Among the people who have died of an accidental overdose in San Francisco in 2023, 280 were determined to have had a fixed address, and 265 of them were San Francisco residents, or 95 percent.[11] San Franciscans are dying in record numbers, and defunding Wellness Hubs – or any other community-based resource – in favor of the jails-based services does nothing to address this.
“I urge you to reallocate 100 percent of the $18.9 million in funding currently designated for “Wellness Hubs” over the next two fiscal years to jail-based treatment and recovery services, so that we may fully operationalize custodial detox, stabilization, assessment, treatment and referrals for this vulnerable population.”
Deprioritizing Wellness Hubs – community identified initiatives of which there are limited, if any, alternative services – and further investing in a law enforcement strategy is a replication of decades of failure. Despite this, Supervisor Dorsey suggests taking two-years of funding for programs that are intended to provide community health resources and services that meet basic survival needs, and instead redirect those funds into San Francisco’s jails. These same county jails are both undoubtedly inappropriate facilities to provide meaningful treatment options and the subject of a federal trial that raises concerns about the carceral conditions in San Francisco.[12]
“Moreover, it makes little sense to me that we would fund and staff limited services for voluntary dro-ins by drug users at a time when we are endeavoring to engage with an involuntary population of drug users whose lawless conduct suggests a far more acute need for life-saving care and robust overdose prevention services.”
While Supervisor Dorsey alludes to an environment where an arrest could result in access to successful substance use treatment, he ignores the actual landscape of treatment resources in San Francisco and that no one is engaging with the coerced treatment model that is in place.[13] There has been chronic underfunding of treatment beds for decades in our city, and many crucial programs – such as dual diagnosis for Spanish speakers and mobile treatment for the unhoused – simply do not exist. Without a definitive strategy to augment the number of treatment slots available to accommodate the rising number of people the City intends to compel to treatment, incarcerating people who use drugs cannot result in a meaningful treatment opportunity. It is unfeasible when one compares the figures of arrests to the resources that are appropriately staffed and available.[14]
Wellness Hubs and voluntary services for people who use drugs are tremendously effective at saving lives and extend far beyond harm reduction. Based on the City’s data, from January 18, 2022, through December 11, 2022, the service statistics for the Tenderloin Center include but are not limited to:
- Cumulative Daily Guests: 124,100
- Meals Provided: 99,039
- Showers Provided: 8,956
- Loads of Laundry: 3,493
- Cumulative Benefits Applications: 1,893 (CalFresh, Medi-Cal, County Adult Assistance Programs)
- Overdoses Reversed: 333
- Shelter Placements: 1,044
- Housing Assessments Conducted: 2,048
This does not include the thousands of other client engagements at the Tenderloin Center for various basic necessities (171,402), providing a safe voluntary space for guests (137,571), and healthcare needs (5,641).[15]
These are the type of services Supervisor Dorsey wants to replace with jail.
“I believe it is imperative that custodial treatment and recovery services now replace Wellness Hubs as the primary strategic cornerstone in our City’s overdose prevention strategy.”
It cannot be overstated that coerced treatment in carceral settings ultimately raises the risk of overdose death. Furthermore, putting treatment in the hands of the criminal legal system, which lacks medical expertise, results in the denial of evidence-based treatment and punishment for returns to use that are a normal part of recovery. Such programs have been linked to high rates of return to use, increased incidence of overdoses, and elevated suicide rates among participants. The risk of fatal overdose is twice as high after involuntary treatment or civil commitment for substance use disorder as opposed to voluntary treatment.[16]
Coerced treatment punishes people for their illness, perpetuates cycles of incarceration, and leads to disparate racial outcomes in health. As we know, Black, Latinx, Indigenous, and other communities of color will be disproportionately impacted by this strategy. Making this policy the cornerstone of our City’s overdose prevention strategy would further compound this through net-widening – an expansion of arresting and charging people who might not otherwise come into contact with the criminal legal system and subjecting them to the attendant lasting traumas.[17]
The rate of fatal overdose is 120 times higher among people recently released from correctional settings.[18] Even if we did have adequate services in our jails, research shows that improving access to substance use treatment and harm reduction supports in jails “cannot replace community-based responses“ – community-based responses, which, again, Supervisor Dorsey wants to defund.[19]
“In my view, the well-being of our communities has been too long forgotten in San Francisco’s approach to public drug use and open-air drug markets.”
Offering readily available, low-threshold, evidence-based, voluntary treatment in the community produces far better outcomes than forcing people into treatment against their will; however, the City has not prioritized this. Government’s failure to provide proven solutions is not an excuse for counterproductive measures enacted for political purposes. Supervisor Dorsey contradicts himself, suggesting that the community has been forgotten, yet proposes to strip it of an $18.9 million investment.
As the San Francisco Treatment on Demand Coalition wrote in a June statement that was quickly endorsed by over 90 organizations, “Enacting proven solutions is made less and less possible as more and more city spending is prioritized for law enforcement. Choosing war on drugs tactics means treatment and services will not be expanded, that existing programs will have to unnecessarily expend resources to address the harms that are caused by a law enforcement-first approach to overdose and substance use, and that existing programs will be at risk of funding cuts.”[20]
“While I remain a staunch supporter of supervised consumption sites as an appropriate and necessary response to our record-shattering fatal drug overdose crisis, the inability of our City and its nonprofit partners to assume the requisite legal risks at this time to offer supervised consumption services diminishes the value of moving forward with the “half-loaf” approach now contemplated by DPH for Wellness Hubs.”
HealthRIGHT 360 has been engaged in advocacy and the implementation of overdose prevention centers in San Francisco since 2015. The organization continues to work collaboratively with our City partners on this issue and is independently raising the necessary funds as per City Attorney David Chiu’s comments that operations may proceed.[21]
While Supervisor Dorsey’s dedication to issues of substance use disorder and overdose are evident, we cannot accept knee-jerk political reactions devoid of factual evidence that rely almost solely on opinion and anecdote. It is essential that our policy decisions are informed by research and evidence. We invite our policymakers to continue to consider these perspectives with a focus on the most effective, humane, voluntary, and successful interventions that are at our disposal.
To address the ongoing overdose crisis, HealthRIGHT 360 recommends doing the following to ensure an effective, comprehensive continuum of care for people who use drugs that is grounded in public health: expand non-discriminatory access to medication for substance use disorder treatment and culturally affirming, voluntary treatment; provide fact-based drug education; fund peer-led programs and tenant-led overdose navigation in supportive housing; scale up drug sobering centers and drug adulterant testing; support and resource syringe services programs; and implement harm reduction interventions such as overdose prevention centers and safer supply.
About HealthRIGHT 360:
HealthRIGHT 360 is a non-profit provider of substance use disorder treatment, mental health services, and primary care to over 47,000 Californians annually, including more than 15,000 San Franciscans. HealthRIGHT 360 provides care that is compassionate, non-judgmental, and evidence-based. We provide services, regardless of one’s ability to pay; inspired by our belief that healthcare is a right, not a privilege. Learn more about HealthRIGHT 360 and our programs at https://www.healthright360.org/
[1] Dorsey, Matt (@mattdorsey). “Today I urged Mayor @LondonBreed to reallocate $18.9M in funding currently budgeted for Wellness Hubs to jail-based treatment and recovery services, which will better serve detainees arrested for public drug use. Here’s my letter and news release.“ August 4, 2023, 5:38 PM, https://twitter.com/mattdorsey/status/1687624163715072000?s=20
[2] Dasgupta, Nabarun. “We Can’t Arrest Our Way Out of Overdose: The Drug Bust Paradox,” American Journal of Public Health, June 7, 2023. https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307329
[3] Carroll, J., del Pozo, B., Ray, B., Hedden, B., Huynh, P., Korzeniewski, S., Mohler, G., and Victor, G. “Spatiotemporal Analysis Exploring the Effect of Law Enforcement Drug Market Disruptions on Overdose, Indianapolis, Indiana, 2020–2021,” American Journal of Public Health, June 7, 2023. https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2023.307291
[4] “Drug Courts are Not the Answer: Toward a Health-Centered Approach to Drug Use,” Drug Policy Alliance, March 21, 2011, https://drugpolicy.org/news/new-report-finds-drug-courts-are-not-answer/
[5] Moench, M. “S.F. police crack down on public drug use ahead of Mayor Breed’s command center targeting dealers,” San Francisco Chronicle, June 2, 2023. https://www.sfchronicle.com/sf/article/sf-drug-dealing-tenderloin-emergency-center-18132343.php
[6] Leonard, C. “‘Enormous rise’ in San Francisco overdose deaths in 2023,” San Francisco Chronicle, April 19, 2023. https://www.sfchronicle.com/sf/article/drug-overdose-deaths-2023-17904060.php
[7] Moench, M. “S.F. arrests 58 drug users in a week as Breed cracks down. Sheriff targets open-air markets, usage,” San Francisco Chronicle, June 8, 2023. https://www.sfchronicle.com/sf/article/sf-mayor-breed-drug-crackdown-sheriff-18140952.php
[8] Neilson, S. “Brooke Jenkins has transformed San Francisco’s crime policies. Here’s what the data shows,” San Francisco Chronicle, March 29, 2023. https://www.sfchronicle.com/bayarea/article/san-francisco-arrests-jail-17837526.php
[9] Lambert, H. “Out-of-towners flocking to California city make up majority of drug arrests, police say,” Fox News, July 28, 2023, https://www.foxnews.com/us/towners-flocking-california-city-make-majority-drug-arrests-police-say
[10] “Drug War History,” Drug Policy Alliance, https://drugpolicy.org/drug-war-history/
[11] Rodda, L. “Accidental Overdose Report, Jan 2023 – June 2023,” OCME Accidental Overdose Reports, Office of the Chief Medical Examiner, July 14, 2023. https://sf.gov/resource/2020/ocme-accidental-overdose-reports
[12] Burkett, E. “San Francisco inmates’ bid for sunlight stumbles with federal judge,” Courthouse News Service, April 5, 2023, https://www.courthousenews.com/san-francisco-inmates-bid-for-sunlight-stumbles-with-federal-judge/
[13] Eskenazi, J. “‘Pretty much everybody is high:’ Inmates languish in jail as influx looms,” Mission Local, November 21, 2022. https://missionlocal.org/2022/11/jail-san-francisco-meth-coke-weed-understaffed/
[14] “Treatment on Demand (Prop T) 2021-2022 Report,” San Fransisco Department of Public Health, Behavioral Health Services February 9, 2023, https://sf.gov/resource/2022/treatment-demand-act
[15] “Tenderloin Emergency Initiative data and reports,” Department of Emergency Management & Department of Public Health, City and County of San Francisco, https://sf.gov/resource/2022/tenderloin-emergency-initiative-data-and-reports
[16] “An Assessment of Opioid-Related Deaths in Massachusetts (2013-2014),” Massachusetts Department of Public Health, September 15, 2016. https://www.mass.gov/doc/legislative-report-chapter-55-opioid-overdose-study-september-2016/download
[17] Drug Policy Alliance, 2011, note 4.
[18] “An Assessment of Fatal and Nonfatal Opioid Overdoses in Massachusetts (2011-2015),” Massachusetts Department of Public Health, August 16, 2017. https://www.mass.gov/doc/legislative-report-chapter-55-opioid-overdose-study-august-2017/download
[19] Beck, J., Miller, C., Tan de Bibiana, J., and Taylor, A. “Overdose Deaths and Jail Incarceration,” Vera Institute of Justice, https://www.vera.org/publications/overdose-deaths-and-jail-incarceration
[20] “Public Health Professionals, Community Organizations, and Housing, Service, and Treatment Providers Condemn Mayor’s Mass Arrests and Coerced Treatment of People Who Use Drugs,” San Francisco Treatment on Demand Coalition, June 14, 2023, https://docs.google.com/document/d/1w4WHDzBXQdNQWE6AyZxHSsca41vOmYFxKyB1J6wSFwc/edit
[21] Moench, M. “S.F. debates funding supervised drug consumption sites with millions from opioid settlement funds,” San Francisco Chronicle, April 11, 2023, https://www.sfchronicle.com/sf/article/sf-supervised-consumption-opioid-settlement-17890940.php
