Dealing With Homelessness and Drug Abuse

By Tamara McClintock Greenberg, PsyD

In her Aug. 15 commentary, Julie Pitta noted, “The difficult truth is that San Francisco’s drug crisis will not be solved overnight.” 

I don’t think anyone in San Francisco is asking for anything overnight. If anything, we’ve been far too patient as we watch the humanitarian crisis on our streets become increasingly intolerable. Vulnerable people, often with histories of trauma and substance abuse disorders, are suffering, as are residents of San Francisco who are collateral damage when they are victims of crime related to our crises, which are broadcast all over the world. Our street conditions in the Bay Area are so dire that the United Nations once declared them “cruel and inhuman.” 

Pitta suggests more housing and an expansion of harm reduction services, but we spend billions (literally, multiple billions) on these strategies and have barely made a dent in the problem. 

As a psychologist, I’ve long been curious about the San Francisco definition and implementation of harm reduction, which started as a social justice initiative in response to inequity related to discriminate law enforcement of drug use. The earliest applications of harm reduction included methadone clinics as well as syringe programs. The former provides longer-term dosing of opiates to prevent withdrawal and to promote a safer way to use substances. Methadone clinics require counseling and case management. A clinic I worked in offered acupuncture to help with drug cravings. Like clean syringes, these programs are designed to keep people safer until and if they decide drug use no longer serves them. 

No matter how one may feel about harm reduction, this approach does not support enabling people to die on the streets. In fact, according to the National Harm Reduction Coalition:

“Harm reduction incorporates a spectrum of strategies that includes safer use, managed use, abstinence, meeting people who use drugs ‘where they’re at,’ and addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve people who use drugs reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.”

Our use of harm reduction here in San Francisco seems quite a bit different, and some may question whether we are reducing dangers associated with substance use. Harm reduction should consider the people suffering from drug addiction as well as the community members who are impacted.

Of course, housing is part of the problem. Yet, we have more supportive housing per capita than almost anyone and San Francisco has among the highest rates of unsheltered homelessness and overdose deaths in the country. 

How do  traumatized people and substance abusers end up in this position in the unique San Francisco landscape? We have an endless network of city-funded non-profit organizations and activists who dictate the terms under which the City operates. Here, the tail wags the dog. The consequences could not be more dire. Our web of failed drug policies has created an inhumane reality that is not only killing people but also dramatically impacts public safety and our economy.

I’m grateful that San Franciscans are banding together and refusing to stand idly by while our City faces rising homelessness and an out-of-control drug epidemic. Our local government has the power to make change, and it’s up to us to compel it.

The problem is complicated and multifactorial. Consider a recent comment on District Attorney Brooke Jenkins’ X page on Sept. 19:

“SFPD has arrested hundreds of drug dealers in the last year+. 

@SFDAOffice has filed 200 motions to keep egregious drug dealers in jail, but only 17 of these motions have been granted.”

            The public deserves to understand why the City faces our current problems and what it will take to fix them. Enter TogetherSF and the bold and controversial, “That’s Fentalife!” campaign, which argues those experiencing homelessness and addiction need more shelter and more treatment. For those who profit off the misery of others by dealing fentanyl, we need accountability. TogetherSF is saying that severe problems require dramatic action. Those of us who have been here for decades have watched our City drown in unspeakable tragedies. 

That proactive, uncomfortable, and shocking approach by TogetherSF may be just what we needed. There will now be an expansion in programs for women and their families to access recovery and support services including transitional housing, drug-free therapeutic teaching communities, expanded step-down drug addiction treatment beds on Treasure Island, sober housing for people with substance use problems, and expanded intake center hours for people seeking substance use treatment. 

There will also finally be major investments to improve public safety and closing open-air drug markets by funding the Drug Market Agency Command Center, to allow involved departments to coordinate their work on the drug crisis; acquiring specialized narcotics detection equipment, continuing the unarmed street ambassador program, continuing the Street Response Teams that directly respond to emergency overdoses and expanding the police department including 220 additional officers over the next two years.

The San Francisco police department has stepped up its efforts significantly. This year they documented nearly 2,460 drug offenses, which is an increase of nearly 36 percent over the same period ending in 2022. Likewise, our new district attorney, Brooke Jenkins, filed more than 800 felony narcotic cases, a 72 percent increase over her predecessor. It spurred Gov. Gavin  Newsom to launch a joint law enforcement surge in San Francisco that has already seized enough fentanyl to kill over 2.1 million people.

Despite this major course shift and early signs of success, critics want San Francisco to double down on the same failed strategies we’ve been deploying for decades. There isn’t anything humane about letting people die on the streets, and there isn’t anything progressive about forcing the children of the Tenderloin to live in violence on a daily basis. 

San Francisco has a disquieting and limited way of implementing harm reduction. San Francisco County might consider a more modern way to treat trauma and addiction, one that can incorporate abstinence, but uses a variety of approaches to support people who are also using. A program called Seeking Safety is one example and has been used by Los Angeles County and throughout the country and is a good way to begin thinking about real, impactful treatment. 

Systemic discrimination, economic inequality and social justice reform need to be a part of the conversation, but real harm reduction is about preventing harm for the vulnerable and the community. We should listen to this new generation of activists who won’t back down until San Francisco is a safer city for all.

Tamara McClintock Greenberg, PsyD is a psychologist and author in San Francisco. Her newest book is The Complex PTSD Coping Skills Workbook.