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San Francisco has enabled drug users for too long. It’s time for compassion—with accountability

Recovery experts argue that the drug screening required under Proposition F provides compassionate accountability to help people struggling with addiction. Enabling drug use hasn’t worked.

A person sits on the floor in a dimly lit hallway, leaning against a wall. They are in a reflective pose, with light shining through a window ahead.
Source: Getty Images

By Cedric Akbar and Steve Adami

Like many San Franciscans, we know what it’s like to experience, witness, care for and lose loved ones struggling with drug abuse. As people who are in recovery, we also know what it takes to confront and recover from the endless cycle of addiction.

Voters made it clear when they passed Mayor London Breed’s Proposition F in March that they wanted to see a change in our city’s approach to addressing the addiction crisis on our streets. A recent opinion in The San Francisco Standard lacks the perspective of people who have struggled with addiction and recovered. 

When it is implemented in January 2025, Proposition F will provide better care and services to people suffering from addiction. Throughout her time in office, Breed has consistently worked with, listened to and learned from those of us in the recovery community to deliver real solutions to some of San Francisco’s most pressing challenges. She’s more than a mayor to many of us—she’s a friend and ally. She understands better than most elected officials that the city’s longstanding harm reduction approach will not solve our city’s addiction crisis alone. 

San Francisco’s approach of tolerating drug use and giving people the freedom to do what they want on our streets was not helping people address their addiction. In some cases, it was enabling it. 

Breed’s approach, by comparison, is a compassionate one. Proposition F does not mandate drug testing, force people into specific treatment programs, or punish those who are not physically or mentally capable of immediately entering a strictly abstinence-based plan. Instead, it will establish accountability measures for those struggling with addiction who receive city-funded care and support.

Support for reintegration

This holistic approach meets people where they are to ensure they have access to the support systems that will allow them to safely reintegrate into our communities once they have recovered. Treatment plans could include taking medication, regularly attending therapy or participating in residential treatment. Health care professionals who meet individually with people will advise which treatment plans best meet their needs.

Rather than requiring drug testing through blood draws or urinalysis, the legislation simply requires individuals to participate in a drug screening in which they talk with a professional who can create an individual treatment plan and connect them to services. People do not have to be perfect in the program, but they have to make an effort. The assumption that Proposition F will kick people off services if they fail a drug test is not just wrong, but a dangerous narrative that will get in the way of real results. 

Yes, for those who undergo a drug screening and are unwilling to enter any kind of city-funded recovery program, their cash benefits will be withheld. But the city will be ready to reinstate their benefits as soon as they participate in their own recovery, tailored to meet their individual needs and goals. Allowing people who are suffering to avoid care has not only put them at risk but has affected the health and safety of all San Francisco residents, families and businesses. 

San Francisco is a compassionate city that prides itself on giving people like us a second chance. But it is not compassionate to let individuals struggle and sadly, too often die, when we have programs that provide comprehensive support and wrap-around services. 

The city has treatment beds available now, in addition to services available from other providers. The mayor supports San Francisco’s continued investment in expanding programs and solutions, including dedicating more than $600 million to behavioral health programs and more than $20 million in new investments in abstinence-based programs.

As a community, we should demand that members of the Board of Supervisors and the Department of Public Health follow Breed’s leadership and advocate for people who need care to have access to it. But we also need to put pressure on policymakers to adopt common-sense solutions that aggressively meet the demands of the current crisis on our streets.

We cannot continue to allow individuals with substance-use dependency to receive city funding without any accountability. Lives are on the line and we must step up to save them.

Cedric Akbar is the executive director of Positive Directions Equals Change and Steve Adami is the executive director of The Salvation Army’s ‘The Way Out’ initiative.

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