STATEMENT BY VITKA EISEN, PRESIDENT & CEO, HEALTHRIGHT 360, IN ADVANCE OF PARTICIPATION AT TOGETHERSF ACTION “DOES SAN FRANCISCO ENABLE DRUG USE?” PANEL ON WEDNESDAY, APRIL 5, 2023
For information on tonight’s TogetherSF Action Panel, visit: https://www.mobilize.us/tsfaction/event/552818/
San Francisco, CA — All opioid overdose deaths are preventable, and every year, thousands of lives are saved by people who use drugs, their peers, and substance use disorder services, which include a broad spectrum of low-threshold strategies.
In the face of a nationwide increase in overdose deaths, there is growing consideration of a return to more punitive responses to illicit drug use and away from evidenced-based practices. San Francisco is no exception to this dangerous, reemerging perspective, but we cannot concede to approaches to public drug use that have been tried and failed for decades, or interventions that only successfully address a small population of people who use drugs.
HealthRIGHT 360 has a proud legacy of being at the forefront of evidence-based public health initiatives, including pioneering both abstinence-based and harm reduction programs to address substance use disorder through a full continuum of care for over 50 years. The Haight Ashbury Free Clinic, founded in 1967 during the Summer of Love, was one of the first such clinics in the nation providing free medical services and substance use treatment with dignity and without judgement, to the city’s most vulnerable populations. Similarly, the Walden House program, founded in 1969, began by providing residential treatment for people experiencing homelessness and runaway adolescents who were struggling with substance use disorder.
Despite incremental yet groundbreaking public health interventions, San Francisco has seen a dramatic rise in public drug use and related harms in recent years. This is largely due to ever-increasing economic factors placing people further into poverty, while the will to scale up successful evidence-based programs has been sidelined due to political discourse and harmful rhetoric. Meanwhile, the opioid overdose crisis and the use of illicit fentanyl or fentanyl analogs has led to a surge in overdose deaths across the country.
We know that criminalizing drug use drives individuals who use drugs further into the margins of our society. People who have been convicted of drug possession, disproportionately Black and Brown people, face drastic disenfranchisement and greater challenges securing housing, employment, federally backed student loans, and even, in many states, the right to vote. Drug-free workplace laws, too, drive individuals who use drugs into the shadows. The current response to drug-use breeds secrecy, deception, and stigma, which leads to substance use in isolation and shame. Driven to purchase drugs from illegal and unregulated sources, our current policies continue to fuel overdose deaths as individuals face the risk of a fatality from adulterated drugs of unknown potency or provenance.
People with substance use disorders should have the right to choose if and when they would like to engage in treatment services; however, many people are subjected to mandated, coerced, or involuntary treatment. Forcing individuals to undergo treatment against their will has a long history in the United States. Not only does this practice violate an individual’s right to make their own decisions about their own healthcare, but there are also further negative consequences, such as increased rates of return to drug use and the potential for physical and psychological harm. Drug courts, which often mandate treatment as a condition to stay out of prison or jail, keep a job, or avoid other punishments, have not demonstrated cost savings, reduced incarceration, or improved public safety; rather, they have misguidedly left many people worse off for participating and helped further intrench more punitive approaches toward addiction – not less.[1]
Since the beginning of the AIDS epidemic, harm reduction strategies have played a crucial role in curtailing the spread of HIV and hepatitis C in San Francisco. These pragmatic strategies were based on the idea that it was important to reduce the negative consequences associated with high-risk behaviors, rather than unrealistically eliminate those same behaviors entirely. Sterile syringe and widespread condom distribution, education campaigns aimed at encouraging safer substance use and sex practices, and HIV testing and counseling services all greatly reduced the risk of transmission through injection drug use and sexual contact. These same programs have been at the forefront of the overdose crisis and the COVID-19 pandemic.
Harm reduction programs are a vital component of any comprehensive approach to treating substance use disorder. These programs recognize that people will continue to use drugs despite the risks, and therefore aim to reduce the harms associated with drug use. Examples of harm reduction strategies include providing sterile syringes, pipes, and other supplies to reduce the risk of HIV and hepatitis C transmission, offering medication for addiction treatment, and providing overdose prevention education and naloxone, a medication that can reverse opioid overdoses.
HealthRIGHT 360 has been providing withdrawal management and residential treatment for many decades, and we have learned quite a bit from the everchanging landscape of substance use disorder in San Francisco and beyond. We have seen that treatment does not work for many people right away, that people may be ambivalent about treatment, or carry shame because they have attempted treatment so many times. We support abstinence, but we also believe in harm reduction because we feel it is our responsibility to make sure folks do not die before they make it back through the doors of treatment.
The War on Drugs was an abject failure, and any return to regressive, dehumanizing approaches that strip people of their rights will undoubtedly yield the same results. Research has shown that voluntary, evidence-based treatment — holistic programs that provide individuals with the support and resources they need to overcome addition — are far more effective at addressing substance use disorder than compelled treatment programs, which focus more on punishment rather than healthcare.[2] San Francisco made a commitment to fully fund and implement Treatment on Demand. By making good on this promise, by providing access to affordable housing and meaningful and reliable voluntary services, and investing in workforce development and a continuum of evidence-based public health interventions — including supervised consumption and safer supply — we can help people improve their health and access to healthcare, recover from substance use disorder, and save lives.
San Francisco has taken steps to reduce its reliance on incarceration by implementing a host of strategies, which include leveraging the coordinated work of dozens of community-based organizations and healthcare providers to serve people faced with drug offenses. Demand for treatment is undeniable, but there is also the urgent need to prevent overdose death and to support people who use drugs that are not ready to enter treatment. HealthRIGHT 360 and other evidence-based treatment providers have been integral to this strategy, offering a compassionate and effective approach to engaging people in care, supporting community integration, and prioritizing public health and human dignity over punishment.
The false dichotomy that pits harm reduction against abstinence is to make the good the enemy of the best. Behavioral change can be, and often is, incremental. Let us not let people die while we quibble over positional differences. We share the same goal of making this city livable for everyone. San Francisco can do better, and we can do this together.
About HealthRIGHT 360:
HealthRIGHT 360 is a non-profit provider of substance use disorder treatment, mental health services, and primary care to over 49,000 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] Drug Courts Are Not the Answer: Toward a Health-Centered Approach to Drug Use. Drug Policy Alliance, March 2011, https://drugpolicy.org/sites/default/files/Drug%20Courts%20Are%20Not%20t…
[2] Involuntary treatment for substance use disorder: A misguided response to the opioid crisis. Harvard, January 2018. https://www.health.harvard.edu/blog/involuntary-treatment-sud-misguided-…
