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San Francisco drug users must enter treatment before receiving cash assistance: Mayor

Mayor London Breed speaks at a press conference in San Francisco. | Source: Jeremy Chen/The Standard

San Francisco Mayor London Breed proposed new legislation Tuesday that would require people with substance use disorders to seek treatment before the city provides them financial support.

As part of an effort to forcefully steer people into addiction treatment, Breed said the city’s General Assistance program—considered a safety net for people who don’t qualify for other means of financial support—would start screening its participants for addiction under the legislation. Those who fail the screening would no longer receive financial support unless they enroll in treatment.

San Francisco’s General Assistance program administered $30.3 million in fiscal year 2022. There are roughly 5,200 people currently in the program.

“No more handouts without accountability,” Breed said at a press conference Tuesday.

Through the General Assistance program, housed participants can receive a maximum of $687 per month, while those who are homeless receive a maximum of $105 per month along with a guaranteed shelter bed due to the Care Not Cash legislation passed in 2002.

Program participants with children would not be included under the new legislation.

Trent Rhorer, executive director of the Human Services Agency, said the share of people with substance use disorders among people who receive these benefits is higher than among the general population.

A man living in the SoMa neighborhood named Gabriel Waller, who said he has colon cancer and is addicted to fentanyl, said he was denied from the city’s General Assistance program. The lack of money hasn’t deterred him from finding other means to obtain drugs, he said.

“Screw the drugs, I’ve been begging for something to drink since like four o clock,” Waller said as he swept tin foil he had smoked fentanyl from off his lap. “Maybe [Breed] needs to feel what I’m feeling right now. My throat is so parched.”

Another man named Andrew Hotchkiss-Carrigan, who said he’d been intermittently living on the streets, speculated that the legislation would lead more people to commit crimes to support their addictions.

Critics of the city’s drug treatment system have said voluntary treatment isn’t widely available or accessible enough for people with addiction. On the morning of Breed’s announcement, a city dashboard showed eight beds available for publicly funded detox programs, which serve as the first step for many people seeking recovery.

Admissions to drug treatment in San Francisco have declined by 37% between 2015 and 2021, and fatal overdoses are occurring at a record pace this year, with 84 people dying in August alone, according to preliminary data.

The Department of Public Health has said the decline in treatment admissions doesn’t necessarily correspond with fewer people starting treatment since the city has increased prescriptions for medically assisted treatment.

However, the department has also said changes in the state’s public insurance system have restricted the city from providing drug treatment for out-of-town patients in recent years.

Breed’s proposed law will be heard by the Board of Supervisors. 

David Sjostedt can be reached at