City-funded public health programs will no longer distribute drug use supplies without providing counseling sessions or connecting recipients to services, Mayor Daniel Lurie announced Wednesday.
The policy shift, effective April 30, applies to all city programs that distribute sterile syringes and smoking kits and prohibits the distribution of smoking supplies in public spaces.
“We can no longer accept the reality of two people dying a day from overdose,” Lurie said. “The status quo has failed to ensure the health and safety of our entire community, as well as those in the throes of addiction.”
Lurie’s administration did not explain in its announcement what will happen at the counseling sessions or how the system will operate.
Nonprofits and advocates were quick to criticize the changes, arguing that the distribution of smoking supplies prevents the spread of disease among drug users.
Laura Guzman, executive director of the National Harm Reduction Coalition, called the rule change “moronic and antithetical to what we know works.” Guzman said many harm reduction nonprofits already offer treatment along with smoking supplies, but making that a requirement could limit the number of people they are able to help.
“If you’re pushing this forward and you don’t already have an array of treatment, it’s disingenuous,” she said. “The question is, is this just going to hinder the ability of certain service providers to actually engage with populations that nobody else is able to engage with?”
The coalition holds contracts with the city to distribute Narcan, an overdose reversal antidote, and to train people to administer it.
Dr. Josh Bamberger, a clinical professor of family and community medicine at UCSF, said the policy could push meth users to share pipes with fentanyl users, increasing their chance of overdosing. There are no medically assisted treatment options for people suffering from meth addiction. Bamberger fears that the mayor’s new policy will further limit opportunities to treat such patients.
“Think about the process of some dude at the end of their speed run, and they don’t have a pipe in front of them,” he said. “They’re tweaking. They’re a mess. They’re going to turn to their buddy who’s using fentanyl and say, ‘Can I use your pipe?’ And then they’re dead.”
The San Francisco AIDS Foundation expressed additional concerns.
“We are disappointed that the distribution of safer smoking supplies will be limited throughout all public spaces in San Francisco, ignoring guidance from leading authorities in evidence-based drug policy,” said CEO Tyler TerMeer. He warned that the policy “may push people toward injection drug use, increasing the risk of fatal overdose and the transmission of HIV, hepatitis C, and other infectious diseases.”
Still, TerMeer said, the foundation remains committed to working with the mayor’s office, the SF Department of Public Health, and community partners to advance solutions “that prioritize compassion and evidence-based care over fear and stigma.”
The foundation will continue offering support services at all locations, including substance use disorder treatment, medical care, HIV and HCV screening and treatment, overdose prevention, and mental health support services, TerMeer added.
‘Helps people recover’
Daniel Tsai, director of the SF Department of Public Health, said his team will monitor overdose rates and HIV/hepatitis C transmission to ensure that the policy aligns with public health goals. The change is part of a broader road map for addressing the fentanyl epidemic, including adding treatment beds and reducing barriers to treatment.
Keith Humphreys, professor of psychiatry at Stanford University, called the new policy “an embrace of what actually helps people recover.”
By May 30, all programs must move distribution indoors or to Public Health-approved controlled spaces.
Tsai told reporters on Wednesday that the shift will be paired with more resources for nonprofits to hire and train counselors.
“We’re going to put our money where our mouth is,” Tsai said. “We are reallocating parts of our existing contracts … so that those nonprofit providers have more resources and have more trained staff.”
The policy follows Lurie’s “Breaking the Cycle” executive directive, aimed at reforming the city’s health and homelessness response. It comes after Lurie declared a Fentanyl State of Emergency on his first day in office, which passed the Board of Supervisors in a 10-1 vote.
The administration also plans to open a 24/7 police-friendly stabilization center this month on Geary Street in the Tenderloin.