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Politics & Policy

Lack of treatment services could tank San Francisco mayor’s drug test plan

Mayor London Breed speaks to the media after giving a speech to San Francisco Police Department’s 280th recruitment class at the San Francisco Police Academy on July 27. | Source: Jeremy Chen/The Standard

Mayor London Breed’s controversial plan to force welfare recipients with addiction issues into treatment caught numerous city officials off guard Tuesday, and the apparently rushed approach not only alarmed local health experts but also led to accusations that the timing was politically motivated. 

Breed’s proposal, which was announced at a press conference early Tuesday, would require people with substance use disorders in the County Adult Assistance Programs to enter treatment before they can receive public funds. It drew swift condemnation from some members of the Board of Supervisors, who called it inhumane and impractical

Aaron Peskin, president of the board, said that Department of Public Health officials told him the agency wasn’t briefed on the plan—which the Mayor’s Office disputed—and that the timing of the announcement was conspicuous. Mayoral candidate Daniel Lurie was kicking off his campaign to challenge Breed in next year’s election around the same time as the mayor’s hurried press conference.

“Not only was the concept half-baked and changed over the course of the day,” Peskin said, “but it also was not lost on me or anybody else that she called a hastily put-together press conference at 9:30 a.m., apparently at about the same time Mr. Lurie was doing his thing.” 

Daniel Lurie speaks at a press conference at the Potrero Hill Neighborhood House after filing paperwork officially announcing his candidacy for mayor of San Francisco on Sept. 26, 2023. Lurie is challenging Mayor London Breed for the position.
Daniel Lurie speaks at a press conference at the Potrero Hill Neighborhood House after filing paperwork officially announcing his candidacy for mayor of San Francisco on Tuesday. | Source: Benjamin Fanjoy for The Standard

The Mayor’s Office sent out a press advisory at 7 a.m. Tuesday, after a schedule of events emailed the prior night noted that Breed’s only event was an evening swearing-in ceremony for a new transportation director.

Jeff Cretan, a spokesperson for the mayor, said in an email that the Human Services Agency “has been considering this idea for some time” and disputed accusations that Breed’s announcement was politically motivated or that the Department of Public Health wasn’t briefed ahead of time.

“That’s what City Hall might care about, but it’s not what the public cares about,” Cretan said. “So people can sit on the sidelines and speculate all they want. But it’s just a distraction from trying to come up with solutions. Let’s hear the ideas.”

San Francisco is on pace to shatter the record for drug overdose deaths in a single year—473 people have died from fentanyl and other drugs in the first seven months of 2023—and the mayor’s plan is seen as a warning to welfare recipients and a deterrent to outsiders. A point-in-time count found that around 70% of people living on the streets reported that they became homeless in San Francisco.

However, complicating matters is a letter from a top public health official—made public Tuesday after the mayor’s announcement—that acknowledged roughly half of people seeking drug detox last spring weren't initially admitted. Many have been left to wonder whether the city has enough services to accomplish the mayor’s plan.

A woman removes drugs from a baggie on the street.
A woman removes drugs from a baggie in the Tenderloin District in San Francisco. | Source: Benjamin Fanjoy for The Standard

Trent Rhorer, executive director of the Human Services Agency, which manages cases for the 5,200 indigent and homeless people in the County Adult Assistance Programs, dismissed critics of the mayor’s plan. He said he approached the City Attorney’s Office about drafting legislation almost a month ago following summer meetings at the Downtown drug command center

“We’re getting a lot of fucking criticism from the media and from the board that this isn’t driven by data,” Rhorer said. “People who’ve known me for 20 years know that data drives everything that we do.” 

However, Rhorer admitted that he did not know how many people would be affected by the mayor’s proposed policy or how the city would obtain the treatment slots.

“If we don’t have the treatment beds, we can’t implement this ordinance,” Rhorer said. “That’s the poison pill.” 

State law allows counties to require people receiving welfare benefits to go into treatment for drug addiction. However, Breed’s proposal would require a local change in law signed off by the Board of Supervisors or potentially a ballot measure taken to voters. An internal memo circulated by the Mayor’s Office suggests 20% of welfare recipients in the city—or about 1,040 people—disclosed substance use issues during an initial interview with the Human Services Agency.

Keith Humphreys, a Stanford professor who worked on drug policy under the Obama administration, said he’s seen no evidence that a proposal like Breed’s will help steer people into treatment. 

“If we were going to prioritize a group to kind of push towards treatment, I would certainly not pick people that need general assistance,” Humphreys said. “Being poor isn’t a crime.” 

He said the proposal may have some utility in deterring people from coming to the city for cash benefits. But if this is the city’s intention, Humphreys added, the mayor should revise her proposal to only perform the drug screening on new arrivals to the city. 

“A lot of people could get ground up and harmed,” Humphreys said, questioning the city’s ability to manage the bureaucracy that would accompany the legislation.

Supervisor Rafael Mandelman, who is co-sponsoring Breed’s legislation, said he was not made aware of the mayor’s plan until Monday afternoon while observing Yom Kippur. He said he broke his observance of the holiday because the Mayor’s Office coordinated a phone call between him and Rhorer that afternoon.

“I am supportive of the idea,” Mandelman said. “And I think, depending on how they roll it out, it could be good, should be good. I hope it’s good? But we’ll have to see what it actually is.”

Supervisor Matt Dorsey, another co-sponsor of Breed’s plan, said he also didn’t learn of the drug testing proposal until Monday. In contrast to the mayor’s announcement, Dorsey said he has been working on legislation with University of California San Francisco hospital officials that would create a sobriety incentive program for welfare recipients in San Francisco that is voluntary.

Supervisor Matt Dorsey listens during a City Hall hearing in January 2023.
Supervisor Matt Dorsey listens at a hearing on the status of safe consumption sites at San Francisco City Hall on Jan. 11, 2023. | Source: Camille Cohen/The Standard

“I don’t think it’s punitive when we’re incentivizing recovery programs,” Dorsey said, adding that he intends to announce his legislation in the next two weeks.

Lurie, who officially announced his campaign to run against Breed less than two hours after the mayor’s press conference, called the timing and substance of Breed’s proposal “an act of political gamesmanship.”

“Her stunt makes pawns of vulnerable San Franciscans who desperately need help, not political exploitation, and will further increase crime,” Lurie said in a statement to The Standard. “There is no better example of why we need to put politics as usual behind us and embrace new leadership, from the outside, for San Francisco.”

The Mayor’s Office defended the drug testing proposal Thursday, saying Breed is looking for “bolder solutions” to deal with the fentanyl crisis. 

“People are focusing on process, and that’s their choice,” Cretan said. “The mayor is focused on pushing forward solutions.”