By David M. Greenwald
San Francisco, CA – With the appointed DA and others pushing for more aggressive enforcement and prosecution of drug dealers and users, on Wednesday, elected San Francisco Public Defender Mano Raju along with an assortment of drug policy experts and treatment providers pushed back, urging evidence-based treatment and harm reduction approaches to address what they believe is a public health crisis.
These experts believe that criminalizing the supply does nothing to abate the demand, and that instead of reinstituting the harmful and failed War on Drugs, public health experts discuss how San Francisco should invest in wrap-around care.
“San Francisco has earned a reputation for being forward-thinking and innovative, and we think it’s really important to not move backward when it comes to the issue of how to tackle substance use disorders,” said public defender Mano Raju.
He noted, “Last week, even at the federal level, President Biden has acknowledged the harmful impacts of the historic war on drugs by announcing that he’s taking an initial step to undo some of the harms. Fifty years of the war on drugs, which is estimated to have cost $1 trillion have demonstrated that arrests, prosecutions, and incarceration inflict more harm and do not reduce substance use disorders or drug sales.”
Raju explained, “Public defenders have been on the front line of this racist war that has targeted Black and brown communities for criminalization. And we know all too well the toll is taken on generations of communities of color,”
He said, “This is why we wanted to come together today to provide an evidence-based perspective on what actually will work to address the opioid crisis in San Francisco. To be clear, as the historic War on Drugs has clearly demonstrated, criminalizing the supply has done nothing to reduce the demand.”
Leo Beletsky, Associate Professor at the UC San Diego School of Medicine explained that “misinformation continues to fuel the war on drugs and racist punitive approaches to substance use and problematic drug use. That misinformation continues to this day and in many ways has played a huge role in the current debate about fentanyl.”
He pointed out that San Francisco is not alone in dealing with the rise in fentanyl-related overdoes.
He noted, “Somehow the former DA’s policies caused a complete stop to drug law enforcement in San Francisco is just not true.
“From an empirical perspective, law enforcement interventions do not actually dismantle drug trafficking organizations,” said Beletsky. “By attacking supply, drug markets mutate and often produce more violence and more potent drugs.”
On the contrary, he argued, “the so-called iron law of prohibition drives increased harm, increased violence in drug markets as a result and crackdowns” and thus “the kinds of rhetoric that’s being thrown around right now in San Francisco is likely to actually fuel the problem that is being purported to be solved.”
Laura Thomas, Director of HIV & Harm Reduction Policy with SF AIDS Foundation agreed “as San Francisco moves forward with increased, uh, policing and criminalization, that those things are going to make the overdose crisis worse.”
She noted that these policies will in fact “make it harder for them to stay safe, harder for them to achieve recovery.”
She said, “We know what does address and prevent overdose fatalities. And that’s where the people in the harm reduction world have the tools, as opposed to the criminal legal system. We need to disinvest in what doesn’t work, and that’s the criminal legal system.”
One of the problems with the current system, Dr. Randolph Holmes, medical director of the Los Angeles Centers for Alcohol and Drug Abuse warned, “There’s a very high risk of people in incarceration overdosing when they get out, because they’re relatively naïve to opiates – they haven’t used them in awhile.”
Del Seymour, a longtime advocate for unhoused individuals and founder of workforce development nonprofit Code Tenderloin, spoke about his personal experience with the last War on Drugs and his assessment of the current situation.
“I’m a veteran of the War on Drugs in the 80s and 90s in San Francisco in the Tenderloin. I spent 18 years heavily addicted to crack cocaine. I have 14 felony arrests on my record,” he said, none for more than $5 of product. He said that his record almost prevented him from buying his first home decades later. “Let’s have a collaborative strategy. I’m tired of going to fentanyl funerals.”
Kara Simon Casey, Supervisor of Ambassadors, Code Tenderloin explained that they are a safe usage site that provides harm reduction, “We are on the ground doing the work daily with people that have substance use issues.”
She explained, “We haven’t lost one life, one soul, not one soul, where we are not advocating the use of drugs. We are advocating safe use, harm reduction, and abstinence is not for everyone. So we do know that. So we just want to provide safety.”
Vitka Eisen, CEO of HealthRIGHT 360, a provider of medical and substance use disorder treatment in San Francisco, recommends the city create a broad network that helps keep people who use drugs connected and engaged in care. In her view, that would include low-barrier wellness hubs and drop-in centers, high-quality voluntary treatment that includes medication for addiction treatment and other evidence-based interventions, safe and stable transitional housing and permanent supportive housing.
“Treatment is effective,” Eisen said. “It is not effective at the same time and in the same way for everybody. Rather than forcing people into treatment, we should follow the experts, and not just one person’s experience, whose recovery journey is relevant only to them.”
Norma Palacios, policy coordinator at the Drug Policy Alliance said she was disappointed by the policies announced by SF public officials.
Palacios said “make no mistake, that these policies are the revival of the war on drugs—a war that have been primarily against communities of color.”
She said, “The evidence points in the opposite direction, that escalating drug enforcement will intensify rather than help address the overdose crisis. San Francisco must adopt proven measures to help address overdose fatalities and to improve community safety.”
These proven policies include funding community-based harm reduction services.
“Treatment options should, should be client centered, must be evidence based, must be affordable, and most importantly, must be culturally sensitive and tailored to the needs of its communities,” she said. “We have to realize that the conditions that we see on the streets of San Francisco is something that didn’t happen overnight, but it’s the result of massive disinvestment of the needs of its residents.”
She said that “criminalizing drug sellers does nothing to end overdoses.”
Instead, she explained: “Oftentimes the people who are arrested for selling drugs are selling to sustain their own drug use. In order to improve community safety, we need to minimize contact with law enforcement and direct people to community-based and culturally competent treatment instead of jails. San Francisco needs to divest from harmful Drug War policies.”