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Leading up to the recent Asia-Pacific Economic Cooperation summit, California Gov. Gavin Newsom created a bit of a controversy when he admitted that the prospect of “fancy leaders” visiting San Francisco was indeed the reason [ [link removed] ] behind efforts to clean up the city. San Francisco isn’t exactly the paragon of what America wants to be showing off to the world these days, and Newsom knows it. But sweeping San Francisco’s myriad problems—from high levels of crime to high levels of homelessness—under the rug for a quickie cleanup in advance of a visit from world leaders is certainly no way to solve the city’s problems in the long run.
One major problem plaguing San Francisco these days is drug abuse—and similar to the hurried cleanup for the APEC summit, the current approach to fixing the issue is not really solving the problem for good and all. Instead, San Francisco leaders must integrate the specific requirements of communities and actively strive to include the knowledge that exists at the community level if they hope to truly end the endemic.
A Drug Abuse Sanctuary
San Francisco is a sanctuary for drug users. A portion of the city’s budget is allocated to distributing roughly 5 million clean needles a year, and roughly 2 million used needles end up on sidewalks scattered [ [link removed] ] through the streets of San Francisco, creating a hazard for public works employees, residents, store owners and tourists. Furthermore, due to the discreet nature of San Francisco, buyers and sellers are free to coordinate, and competition among suppliers results in lower costs, leading to increases in demand.
What we are left with is a less-than-ideal solution for those looking to fight the drug abuse endemic, as a thriving black market has been created for those who are looking to buy and sell opioids. Credible information on the street can lead interested parties to sellers, who in return can distinguish who is and who is not an undercover investigator. More than likely, the product in question is fentanyl [ [link removed] ], an extremely lethal opioid. When medical professionals respond to an overdose call, they must take great care to ensure they do not accidentally inhale fentanyl.
Over the last decade, San Francisco has seen staggering increases in overdose deaths, particularly due to opioids that have funneled into the Tenderloin District at alarming rates. According to research [ [link removed] ] published in the International Journal of Drug Policy, fentanyl-related overdose deaths in San Francisco skyrocketed between 2009 and 2019—from 1.1 to 27.1 per 100,000 people. Today, two San Franciscans die from a fentanyl-related overdose [ [link removed] ] every day.
City leaders realize this is a crisis. Toward the end of 2021, San Francisco Mayor London Breed declared a state of emergency [ [link removed] ], citing the recent rise in overdoses as a serious cause of concern to all San Franciscans. This call to action was naturally a prompt to introduce several citywide ordinances to address the problem, the most prominent being the Tenderloin Emergency Initiative [ [link removed] ]. This plan created temporary emergency sites to help get those suffering with addiction into treatment facilities, hopefully minimizing violence within the Tenderloin District.
The Tenderloin plan provided the basis for one targeted to all parts of San Francisco: City Department of Public Health [ [link removed] ] officials released a comprehensive overdose prevention plan in 2022. Included in the plan was the provision of 110 treatment beds and 30,000 units of naloxone to combat serious cases of potential overdose, with a goal of reducing overdose deaths by 15% by 2025.
I must say, though, that I am skeptical that this latest plan will really help. The policy approach to San Francisco’s drug endemic has been dubbed “harm reduction,” but it does anything but. Addicts are repeatedly finding ways to get their hands on more opioids, perpetuating the cycle that is laying waste to hundreds of city residents. These temporary “wellness centers” and treatment sites boast large enrollment numbers, so it’s assumed that people are getting the help they need. But they’re not: While the treatment centers provide first aid and lifesaving medication, they don’t focus on treating addiction. Yet the high enrollment numbers are empowering citywide leaders to lobby for the continuation of these facilities. And the bad cycle continues.
A Better Way
If the current system isn’t working, then what could work to ameliorate San Francisco’s drug problem? One option might be a market-based approach to combating rising fentanyl-related overdose deaths, which could involve a combination of regulatory measures, economic incentives and industry collaboration. If we could incentivize good behavior and impose penalties on repeated offenders who enter into treatment centers, the rate of overdoses may fall.
While a market-based approach may help, a closer examination of the interactions between state and local government may provide greater clarity into how this might work. The state government will often act as a manager [ [link removed] ] and hear from local officials on how to best facilitate the transfer of funds to counties that need the money the most. However, there is no incentive for either party to take responsibility for the policies that they implement, as they will never be on the receiving end of them. Moreover, this leaves the most vital individuals out of the question, the very community members whose opinions on the matter are integral to solving the problem. By involving those who are most affected by the endemic, solutions can not only be specific but also lead to better outcomes for all.
Take High Point, North Carolina’s Drug Market Intervention plan [ [link removed] ]. Introduced in 2004, this plan aims to dismantle the drug markets known to authorities and enhance the quality of life for residents in adjacent communities. DMI involves the identification of specific drug markets and street-level dealers, the apprehension of violent offenders, the initiation of “banked” cases (where prosecution is temporarily suspended) for nonviolent dealers, and the convening of a call-in meeting that brings together dealers, their families, law enforcement officials, service providers and community leaders to emphasize the cessation of open drug sales.
The Drug Market Initiative entails minimal arrests for nonviolent dealers and deviates from traditional practices, leading to a profound transformation of the targeted areas. The outcomes are both immediate and capable of being maintained over an extended period—a 57% decrease in violence [ [link removed] ] was observed over the course of six years. The communities in these neighborhoods actively assume responsibility for ensuring safety in their localities, hence placing a great deal of emphasis on those who are on the ground.
Similarly, in Huntington, West Virginia, a Quick Response Team was assembled as part of a joint initiative involving law enforcement, medical care providers, mental health agencies and university researchers—designed to swiftly address the opioid epidemic. Within 72 hours of a drug overdose, the team helps by assessing an individual’s needs, symptoms and strengths, with the aim of devising an appropriate intervention plan. This systematic approach enhances access to recovery and treatment services while minimizing barriers to care. By involving local community experts, leaders have the context needed to make better decisions.
Fostering a market for drug activity [ [link removed] ] while funding a welfare treatment state with no measurable results isn’t beneficial for patients or taxpayers. An estimated $3 billion [ [link removed] ] per year is allocated by the city toward public health. Using these funds to educate and promote preventative practices while exploring wide varieties of treatment opportunities can help those addicted to opioids.
There’s a lesson in all of this. The bureaucratic process does little to address the problems on the ground, and throwing funding at local governments won’t solve the overall issues San Francisco faces. Finding ways to apply local knowledge while reducing violent crime in the surrounding areas is the balance that Mayor Breed and other city leaders must strive to achieve.
All lawmakers should be focused on how to best serve their constituents—and that includes those struggling with addiction. While officials may be benevolent, though, it is all but impossible for them to have the on-the-ground knowledge they need to effectively deal with problems at the community level. Hence, the need for collaborative government at all levels is crucial, especially in San Francisco where impractical welfare policies have expanded greatly in the last decade. Locally informed policy revision is urgently needed to target the problem at hand, while reminding bureaucrats of the responsibilities they have to all their constituents.

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